Comparison of three airway management techniques in a simulated tactical setting

Several different methods for emergent airway management are feasible in the tactical environment. Current studies fail to identify which method minimizes the exposure of the tactical medic or which is most rapid with the greatest chance of first-attempt success.

We evaluated three commonly used airway management techniques, including standard direct laryngoscopy with endotracheal intubation, digital endotracheal intubation, and use of the King LT laryngotracheal airway device. Study participants were volunteer emergency medicine (EM) residents and medical flight crew members with difficult airway management skills. We compared the times to successful ventilation, numbers of attempts to successful ventilation, and heights of presentation of the participants above a barricade used to simulate concealment.

Thirty-one subjects completed the study, of whom 12 (39%) were medical flight crew members and 19 (61%) were EM residents. All subjects were able to successfully ventilate manikins using each of the three methods. The mean number of attempts to intubate and ventilate the manikin was 1.03 for direct laryngoscopy, 1.26 for the King LT, and 1.67 for digital endotracheal intubation. Mean time to ventilation was 59.7 seconds for the King LT, 63.3 seconds for laryngoscopy, and 125.4 seconds for digital intubation. The maximum height the medic reached above the barricade during airway management was 17.7 inches for the King LT, 19.7 inches for laryngoscopy, and 23.5 inches for digital intubation. Comparison of all three factors across groups showed significance, with the exception of time to ventilation between laryngoscopy and use of the King LT.

In a simulated tactical airway management scenario, use of the King LT provided less exposure than digital or standard endotracheal intubation techniques. Digital intubation behind the simulated barricade was the least successful by all measures. Although direct laryngoscopy was the most successful on the first attempt, use of the King LT in our scenario provided the least exposure of the medic and was as effective as direct laryngoscopy with regard to time to ventilation. Key words: TEMS; airway management; simulation; tactical environment; combat medicine.