Securing the prehospital airway: a comparison of laryngeal mask insertion and endotracheal intubation by UK paramedics

Objectives: The recent introduction of a disposable laryngeal mask airway has provided paramedics with an alternative to endotracheal intubation. Time taken to secure the airway with each device was compared in patients undergoing elective surgery. Methods: Patients undergoing general anaesthesia were studied. Paramedics trained in laryngeal mask use and endotracheal intubation participated in the study. A Portex disposable laryngeal mask was inserted and removed, followed by a Portex endotracheal tube. Time taken from beginning of the procedure to ventilation of the patient was recorded. Results: Laryngeal mask insertion and endotracheal intubation was attempted on 52 patients. Median age was 63.5 years ( range 39 - 83). Laryngeal mask insertion was successful in 88.5% ( 46 of 52) patients; endotracheal intubation was successful in 71.2% ( 37 of 52) patients ( after no more than two attempts), p = 0.049. Intubation success was related to laryngoscopic view (87.5% grade 1, 56.3% grade 2, 0.0% grade 3. p< 0.0001). When laryngeal mask/endotracheal tube insertion were both successful ( n = 35 of 52), there was no significant difference in median time to secure the airway ( laryngeal mask 47.0 seconds ( range 24 - 126) compared with endotracheal tube 52.0 seconds ( range 27 - 148) p = 0.22). Laryngeal mask insertion was successful in 80.0% ( 12 of 15) patients in whom endotracheal intubation had failed. Conclusions: Even under optimal conditions, 30% of attempts at intubation by paramedics were unsuccessful. A disposable laryngeal mask has a higher success rate in securing the airway and overall, secures the airway more reliably than endotracheal intubation.