Abstract
OBJECTIVE:The role of supraglottic airway devices in emergency airway management is highlighted in international airway management guidelines. We evaluated the application of the new generation laryngeal tube suction (LTS-II/LTS-D) in the management of in-hospital unexpected difficult airway and cardiopulmonary resuscitation.METHODS:During a seven-year period, patients treated with a laryngeal tube who received routine anesthesia and had an unexpected difficult airway (Cormack Lehane Grade 3-4), who underwent cardiopulmonary resuscitation, or who underwent cardiopulmonary resuscitation outside the operating room and had a difficult airway were evaluated. Successful placement of the LTS II/LTS-D, sufficient ventilation, time to placement, number of placement attempts, stomach content, peripheral oxygen saturation/end-tidal carbon dioxide development (SpO2/etCO2) over 5 minutes, subjective overall assessment and complications were recorded.RESULTS:In total, 106 adult patients were treated using an LTS-II/LTS-D. The main indication for placement was a difficult airway (75%, n=80), followed by cardiopulmonary resuscitation (25%, n=26) or an overlap between both (18%, n=19). In 94% of patients (n=100), users placed the laryngeal tube during the first attempt. In 93% of patients (n=98), the tube was placed within 30 seconds. A significant increase in SpO2 from 97% (0-100) to 99% (5-100) was observed in the whole population and in cardiopulmonary resuscitation patients. The average initial etCO2 of 39.5 mmHg (0-100 mmHg) decreased significantly to an average of 38.4 mmHg (10-62 mmHg) after 5 minutes. A comparison of cardiopulmonary resuscitation patients with non-cardiopulmonary resuscitation patients regarding gastric contents showed no significant difference.CONCLUSIONS:LTS-D/LTS-II use for in-hospital unexpected difficult airway management provides a secure method for primary airway management until other options such as video laryngoscopy or fiber optic intubation become available.
Highlights
Patients with an unexpected or anticipated difficult airway requiring emergency airway management remain a challenge, even for experienced anesthesiologists and emergency physicians
Within the seven-year study period, data were available for 106 adult patients (78 males, 28 females) who had their airway managed with the LTS-II/LTS-D in the context of an unanticipated difficult airway and/or in-hospital resuscitation
In 94% (n=100) of the cases, users were able to place the laryngeal tube during the first attempt; with two attempts, the success rate increased to 99% (n=105)
Summary
Patients with an unexpected or anticipated difficult airway requiring emergency airway management remain a challenge, even for experienced anesthesiologists and emergency physicians This condition is responsible for major anesthetic complications, which result in significant morbidity and mortality [1]. Airway management outside the OR is mainly influenced by environmental, equipment, and assistance issues and is associated with a 10-fold higher risk of a failed intubation [3,4,5]. In these situations, sufficient oxygenation and ventilation receive the highest priority, followed by avoiding aspiration to prevent serious complications
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