Paramedic tracheal intubation using the intubating laryngeal mask airway

Tracheal intubation through the intubating laryngeal mask airway (ILMA) has been evaluated, in controlled settings, as an acceptable alternative to laryngoscopic intubation. Our observational study was designed to examine the success rate of tracheal intubation using the ILMA in the prehospital setting after mannequin-based training.

We examined all oral tracheal intubations performed by the Tasmanian Ambulance Service (TAS) from April 2005 to April 2006. TAS paramedics are occasional intubators, as defined in the study by Reeves et al.,(8) on average performing two intubations per paramedic per year. Fifty-eight paramedics received training in tracheal intubation through the ILMA. The primary outcome measure was tracheal intubation success. Our hypothesis was that paramedics would be able to successfully perform out-of-hospital tracheal intubation using the ILMA with minimal training.

During the study period, 106 patients had out-of-hospital tracheal intubation performed by ambulance paramedics. Comparisons were made between the intubations with the ILMA and by laryngoscopy. The overall intubation success rate was 91% with the laryngoscope and 92% with the ILMA. The success rate for the first attempt at intubation was higher with the ILMA (81%) than with direct laryngoscopy (57%) (RR (95% CI): 1.74 (95% CI: 1.18-2.59, p = 0.009), regardless of ultimate success. The success rate when intubating unconscious patients using the ILMA was significantly higher (88%) than intubation using the laryngoscope (63%). These intubations were achieved without the administration of any sedation or paralytic medication.

Intubation via the ILMA was as successful as conventional laryngoscopic intubation, requiring fewer attempts, although this was not statistically significant.