Therapeutics
The intubating laryngeal-mask airway may be an ideal device for airway control in the rural trauma patient,☆☆,

https://doi.org/10.1053/ajem.2003.50012Get rights and content

Abstract

A review of the literature on advanced airway management indicates that the intubating laryngeal-mask airway (ILMA) may be an ideal device for airway control in the rural trauma patient. The ILMA is an advanced laryngeal-mask airway designed to allow oxygenation of the unconscious patient as well as blind tracheal intubation with an endotracheal tube. The ILMA is an easy-to-use airway with a high success rate of insertion, and requires little training. For the rural physician managing a difficult airway in a trauma patient, the ILMA has been found to be reliable and successful when other techniques fail, such as fiberoptic intubation and direct laryngoscopy. The ILMA has also been reported to cause less hemodynamic change and less injury to the teeth and lips than direct laryngoscopy. Further, the ILMA was found to be easier and faster to use with a higher success rate than either the combitube or endotracheal tube for unskilled healthcare providers. Limitations and complications of the ILMA may include aspiration, esophageal intubation, damage to the larynx or other tissues during blind passage of a tracheal tube, and edema of the epiglottis. (Am J Emerg Med 2003;21:80-85. Copyright 2003, Elsevier Science (USA). All rights reserved.)

Section snippets

Background

The laryngeal mask airway (LMA) was first described in 1983 by Brain, and has been commercially available in the United Kingdom since 1988.6 In the years since its introduction, the LMA has gained wide acceptance throughout Europe and the United States. The LMA is a mask that fits over the larynx, in a way similar to the way in which a face-mask fits over the face. It is oval, with an inflatable balloon surrounding its periphery and a tube that serves as a conduit between the mask and the

Conclusion

The care given during the “golden hour” after trauma is the most crucial determinant of eventual outcome.17 Patient management during this critical period often lies in the hands of paramedical personnel or rural emergency physicians. The primary goal in resuscitation is to establish a patent airway to allow adequate oxygenation, yet prevent pulmonary aspiration of blood and vomitus. Difficulty arises in that the trauma patient who presents to a rural ED with the need for establishment of an

Acknowledgements

The author thanks Dr Matt Layman, MDA, of the Anesthesia Department of Regions Hospital, for his time and commitment in advising on writing this manuscript.

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  • Cited by (28)

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      In addition to working as a ventilatory device, the ILMA also possesses an epiglottic-elevating bar to place the epiglottis in an anterior position to enable the device to be used as a conduit for endotracheal intubation. The standard method for this process is blind anterograde intubation of an endotracheal tube (ETT) through the ILMA (11). If blind intubation is unsuccessful, a bronchoscope can be used through the ILMA to place the ETT.

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      In a number of patients with difficult airways, including morbid obesity and immobile cervical spine, the ILMA was shown to be effective when used by experienced anaesthetists and by emergency physicians.9,10 These encouraging results have reinforced the notion that the ILMA may be an ideal device for advanced out-of-hospital and emergency department airway management.11–13 The use of the ILMA for airway management in the out-of-hospital setting has been described in case reports as well as in a prospective study and has demonstrated its feasibility in this setting.14–18

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      The incidence of difficult intubation (DI) varies from 4 to 11% in pre-hospital emergencies when TI is performed by emergency physicians and from 0.4 to 4% in the operating room (OR).1–5 In emergency situations, the main aim is to maintain oxygenation and ensure efficient ventilation because airway control and ventilation support influence patient outcome.6 The intubating laryngeal mask airway (ILMA) was designed to perform blind tracheal intubation.

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    Manuscript returned August 1, 2001.

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