An Evaluation of Four Supraglottic Airway Devices by Paramedics in a Simulated Condition of Entrapped Trauma Patients-A Randomised, Controlled Manikin Trial

Introduction: Supraglottic airway devices play an important role in airway management in both pre-hospital as well as in-hospital settings. They are a well-recognised alternative to definitive airways in current medical practice. However, despite their wide use in clinical practice, little is known about their performance in patients with restricted access. This study aims to evaluate the time required to insert a supraglottic airway device and achieve a successful ventilation of four different devices in a simulated condition of an entrapped trauma patient with simultaneous cervical spine immobilisation. The ease-of-use and first-attempt success rate were also assessed. Methods: Fully qualified paramedics participated in this randomised, controlled manikin trial. A manikin with the cervical collar on was placed on the driver's seat of a passenger car. Access to the manikin was only allowed from the front. The I-gel, the SLIPA, the LMA Supreme, and the Ambu AuraGain were evaluated. The time required to insert the device and achieve successful ventilation was recorded. The first-attempt success rate and the ease-of-use by the operator were also assessed. Results: The LMA Supreme required the shortest mean time to insert and ventilate the manikin, 10.5 s (±1.7) vs. 16.4 s (±8.4), p < 0.001. The use of the LMA Supreme was associated with the highest first-attempt success rate-88%. The SLIPA device outperformed all other studied devices with regard to ease-of-use and user-friendliness. Its mean score was 8.3 out of 10. Conclusions: The LMA Supreme was superior in terms of both the insertion-to-ventilation time as well as the first-attempt success rate. The SLIPA device was found to be easier to use and more user-friendly.