Laryngeal Tube Research Articles

Abstract 319: Return of Spontaneous Circulation is Not Affected by Gastric Distension

Introduction: Gastric distension is a common complication after CPR and is caused by excess gastric inflation. Consequently, regurgitation of gastric contents and diaphragmatic eventration with increased intrathoracic pressure can occur, which may lead to anoxia and ventricular diastolic dysfunction. We measured gastric volume of out-of-hospital cardiac arrest (OHCA) patients using computed tomography (CT) scan images, and examined the effect of gastric distension on the return of spontaneous circulation (ROSC). Hypothesis: Gastric distension from over-inflation is associated with decreased incidence of ROSC. Methods: We conducted a retrospective observational study with OHCA patients transported to Tsuyama Chuo Hospital from 2014 - 2017. We included cases with total body CT scan examined after ROSC or death. We excluded inter-facility transport and insertion of gastric tube before CT. We measured the total gastric volume using 3D imaging software (FUJIN Anatomia, AZE, Tokyo). Primary outcome: Comparison of gastric volume between patients with and without ROSC. Secondary outcome: Factors associated with increased gastric volume. Mann Whitney U-test was used for the primary outcome. Multivariable regression analysis was used for the secondary outcome. Results: 446 cases were included in the study. Median age was 79 [IQR: 68 - 86], 55% was male, 4% with initial rhythm VF/VT, 45% was estimated cardiac origin, 37% was witnessed arrest, 27% had ROSC. The total gastric volume was 400ml [192 - 793]. There was no difference in gastric volume between ROSC group and no-ROSC group (418 [232 - 733] vs 389 [183 - 824], p = 0.46). Airway management maneuver on arrival did not affect gastric volume (bag-valve-mask β: -99; 95% CI: -250 - 52, laryngeal tube β: -85; 95% CI: -228 - 59, endotracheal intubation: reference). Longer transport time was associated with increased the gastric volume (β: 5.6; 95% CI: 1.0 - 10) as was a non-cardiac origin of arrest (β: 121; 95% CI: 34 - 208). Conclusion: Abdominal distention was not associated with ROSC. Type of initial airway management did not significantly affect gastric volume. Factors associated with increased gastric volume at emergency department arrival were longer transportation time and non-cardiac origin of arrest.

100 Successful Endotracheal Tube Exchange for Laryngeal Tubes in the Emergency Department

100 Successful Endotracheal Tube Exchange for Laryngeal Tubes in the Emergency Department

Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest

Emergency medical services (EMS) commonly perform endotracheal intubation (ETI) or insertion of supraglottic airways, such as the laryngeal tube (LT), on patients with out-of-hospital cardiac arrest (OHCA). The optimal method for OHCA advanced airway management is unknown. To compare the effectiveness of a strategy of initial LT insertion vs initial ETI in adults with OHCA. Multicenter pragmatic cluster-crossover clinical trial involving EMS agencies from the Resuscitation Outcomes Consortium. The trial included 3004 adults with OHCA and anticipated need for advanced airway management who were enrolled from December 1, 2015, to November 4, 2017. The final date of follow-up was November 10, 2017. Twenty-seven EMS agencies were randomized in 13 clusters to initial airway management strategy with LT (n = 1505 patients) or ETI (n = 1499 patients), with crossover to the alternate strategy at 3- to 5-month intervals. The primary outcome was 72-hour survival. Secondary outcomes included return of spontaneous circulation, survival to hospital discharge, favorable neurological status at hospital discharge (Modified Rankin Scale score ≤3), and key adverse events. Among 3004 enrolled patients (median [interquartile range] age, 64 [53-76] years, 1829 [60.9%] men), 3000 were included in the primary analysis. Rates of initial airway success were 90.3% with LT and 51.6% with ETI. Seventy-two hour survival was 18.3% in the LT group vs 15.4% in the ETI group (adjusted difference, 2.9% [95% CI, 0.2%-5.6%]; P = .04). Secondary outcomes in the LT group vs ETI group were return of spontaneous circulation (27.9% vs 24.3%; adjusted difference, 3.6% [95% CI, 0.3%-6.8%]; P = .03); hospital survival (10.8% vs 8.1%; adjusted difference, 2.7% [95% CI, 0.6%-4.8%]; P = .01); and favorable neurological status at discharge (7.1% vs 5.0%; adjusted difference, 2.1% [95% CI, 0.3%-3.8%]; P = .02). There were no significant differences in oropharyngeal or hypopharyngeal injury (0.2% vs 0.3%), airway swelling (1.1% vs 1.0%), or pneumonia or pneumonitis (26.1% vs 22.3%). Among adults with OHCA, a strategy of initial LT insertion was associated with significantly greater 72-hour survival compared with a strategy of initial ETI. These findings suggest that LT insertion may be considered as an initial airway management strategy in patients with OHCA, but limitations of the pragmatic design, practice setting, and ETI performance characteristics suggest that further research is warranted. ClinicalTrials.gov Identifier: NCT02419573.

Fiberoptic-Guided Use of an Airway Exchange Catheter During Exchange of a Kinked King LTS-D Laryngeal Tube for an Endotracheal Tube: A Case Report

The use of supraglottic airway devices such as the King LTS-D laryngeal tube has increased in the prehospital setting because of their relative ease of successful insertion, even in the hands of inexperienced providers. However, these devices have their own associated complications. In patients with a known or suspected difficult airway, supraglottic airway device exchanges should occur under controlled conditions using an airway exchange catheter, preferably under direct visualization with a flexible fiberoptic bronchoscope. We report unanticipated difficulties with supraglottic airway exchange caused by a kinked King LTS-D laryngeal tube.

P2733Prognostic implications of preclinical airway management with laryngeal tube (LTS-D) or endotracheal tube in out-of-hospital cardiac arrest patients

P2733Prognostic implications of preclinical airway management with laryngeal tube (LTS-D) or endotracheal tube in out-of-hospital cardiac arrest patients

Efficiency Comparison of Laryngeal Tube Suctions and Classic Laryngeal Mask Airways through General Anesthesia with Controlled Ventilation

Efficiency Comparison of Laryngeal Tube Suctions and Classic Laryngeal Mask Airways through General Anesthesia with Controlled Ventilation

Gold Nanoparticle-Modified Poly(vinyl chloride) Surface with Improved Antimicrobial Properties for Medical Devices.

Despite the significant technological progress achieved in the past decades in the medical field, device-related infections carry a heavy social and economic burden. Surface modification of medical equipment is one of the most interesting approaches employed to improve the antibacterial activity of a material. Herein, we developed a process for the gold nanoparticle modification of a poly(vinyl chloride) laryngeal tube, which typically serves as an airway management device. In our study, we focused specifically on increasing the antimicrobial properties of the material while maintaining its biocompatibility. We applied two different modification methods to the poly(vinyl chloride) laryngeal tube. An increase in the antimicrobial activity of the surface was observed for both methods. In addition, the adsorption of bacterial cells on the material surface was assessed. We determined that the number of colonies cultured in the presence of the gold nanoparticle-modified samples or absorbed to the material surface decreased significantly compared with the control group. The trend was observed for both Gram-positive and Gram-negative strains. Moreover, it was established that the designed material did not exhibit a lethal impact on a control cell line. Finally, we noted discrepancies in the growth of bacteria cultured in the presence of modified or unmodified PVC material as well as differences in cell adherence to its surface. The proposed poly(vinyl chloride) modifications are most effective against Gram-positive bacteria, especially L. monocytogenes. Nevertheless, it ought to be emphasized that due to their different properties, each strain requires an individual approach.

Comparison of the Force Required for Dislodgement Between Secured and Unsecured Airways

Introduction: Airway device placement and maintenance are of utmost importance when managing critically ill patients. The best method to secure airway devices is currently unknown. Study Objective: We sought to determine the force required to dislodge 4 types of airways with and without airway securing devices. Methods: We performed a prospective study using 4 commonly used airway devices (endotracheal tube [ETT], laryngeal mask airway [LMA], King laryngeal tube [King], and iGel) performed on 5 different mannequin models. All devices were removed twice per mannequin in random order, once unsecured and once secured as per manufacturers’ recommendations; Thomas Tube Holder (Laerdal, Stavanger, Norway) for ETT, LMA, and King; custom tube holder for iGel. A digital force measuring device was attached to the exposed end of the airway device and gradually pulled vertically and perpendicular to the mannequin until the tube had been dislodged, defined as at least 4 cm of movement. Dislodgement force was reported as the maximum force recorded during dislodgement. We compared the relative difference in the secured and unsecured force for each device and between devices using a random-effects regression model accounting for variability in the manikins. Results: The median dislodgment forces (interquartile range [IQR]) in pounds for each secured device were: ETT 13.3 (11.6, 14.1), LMA 16.6 (13.9, 18.3), King 21.7 (16.9, 25.1), and iGel 8 (6.8, 8.3). The median dislodgement forces for each unsecured device were: ETT 4.5 (4.3, 5), LMA 8.4 (6.8, 10.7), King 10.6 (8.2, 11.5), and iGel 3.9 (3.2, 4.2). The relative difference in dislodgement forces (95% confidence intervals) were higher for each device when secured: ETT 8.6 (6.2 to 11), LMA 8.8 (4.6 to 13), King 12.1 (7.2 to 16.6), iGel 4 (1.1 to 6.9). When compared to secured ETT, the King required greater dislodgement force (relative difference 8.6 [4.5–12.7]). The secured iGel required less force than the secured ETT (relative difference −4.8 [−8.9 to −0.8]). Conclusion: Compared with a secured device, an unsecured airway device requires only half the force to cause airway dislodgement. The secured King had the highest dislodgement force relative to the other studied devices.

Performance and skill retention of five supraglottic airway devices for the pediatric difficult airway in a manikin

Supraglottic airway devices (SADs) have been introduced to assist medical professionals in emergency situations with limited experience in securing airways via conventional endotracheal intubation (ETI). Literature on the use of SADs for securing an airway during pediatric critical settings is scarce, and there is a lack of studies comparing different SADs to each other and to conventional ETI. We conducted a study comparing five different SADs to ETI with regard to success rate, time to first ventilation, and personal rating in a pediatric manikin under simulated physiologic and pathologic airway conditions in 41 pediatricians of varying clinical experience and training. Only the AirQ, AuraG, and laryngeal tube (LT) were inserted within 30 s correctly by all participants under physiologic conditions. In tongue edema (TE), AirQ and LT had the highest success rate. In limited mobility of the cervical spine (CS), AirQ, AuraG, and LT again all were inserted within 30 s. In a multivariate analysis, factors influencing the success were experience with the respective device and level of medical education. Under TE conditions, there were significantly longer insertion times for the ETI, laryngeal mask airway (LMA), and EzT. Under CS conditions, there were significantly longer insertion times for the ETI, LMA, LT, and EzT. A multivariate analysis showed experience with the respective device to be the only factor of influence on time to first ventilation.Conclusion: LT, AuraG, and AirQ were superior in providing fast and effective ventilation during simulated difficult airway situations in pediatricians.What is Known:• Supraglottic airway devices have been introduced for medical professionals who lack experience for managing difficult airway situations.• A variety of these devices have been developed so far, but not compared to each other yet.What is New:• We compared five different supraglottic airway devices with regard to success rate, time to first ventilation, and personal rating in a pediatric manikin under simulated physiologic and pathologic airway conditions.• Laryngeal tube, AuraG, and AirQ were superior in providing fast and effective ventilation during simulated difficult airway situations in pediatricians with varying clinical experience.

Comparing the Performance of the Laryngeal Tube Suction with Cuffed Endotracheal Tube during General Anesthesia with Controlled Ventilation in Elective Surgeries : A Prospective, Block - Randomized, Single - Blinded, Parallel Group Trial

Comparing the Performance of the Laryngeal Tube Suction with Cuffed Endotracheal Tube during General Anesthesia with Controlled Ventilation in Elective Surgeries : A Prospective, Block - Randomized, Single - Blinded, Parallel Group Trial

A randomized controlled trial comparing gastro-laryngeal tube with endotracheal intubation for airway management in patients undergoing ERCP under general anaesthesia

BackgroundGastro laryngeal tube (GLT) is a newly introduced device. It is an advanced purpose specific design (essentially a modified laryngeal tube) which especially provides a separate wide channel specifically designed for the introduction of a gastroscope for endoscopic retrograde cholangio-pancreatography (ERCP), simultaneously functioning as a supra-glottic airway device for ventilation. MethodsIn a randomized controlled trial on 100 patients undergoing ERCP under GA, GLT was compared with endotracheal tube as an alternative airway device. Device insertion conditions, oxygenation and ventilation parameters were recorded. ResultsGLT was found to be comparable with ETT. Success rate of insertion of GLT was high (92%) and the insertion time of GLT was significantly shorter 42 (20–210)s vs. 206 (176–320)s – median (range). Both the devices were equally effective in normal oxygenation and ventilation. The recovery time was significantly shorter and postoperative complications such as hoarseness and dysphonia were less common in GLT group. Inserting conditions for the duodenoscope were better in GLT group. ConclusionIn this study, likely to be first of its kind, it is concluded that the GLT is a suitable and better alternative to ETT as it allows adequate ventilation and is associated with faster recovery times and minimal extubation-related complications while enhancing operative conditions for gastroenterologists. Its regular use in patients undergoing ERCP is strongly recommended.

Intubating laryngeal tube suction device (iLTS-D) requires ‘Mandheeral 1 and Mandheeral 2’ manoeuvres for optimum ventilation

The recently introduced iLTS -D® combines the characteristics of laryngeal tube suction-D with the added possibility of secondary tracheal intubation. The manufacturer has provided a method to insert the novel device, iLTS-D. With 45-patients worth of experience, two manoeuvres, i.e. Mandheeral 1 and Mandheeral 2, are recommended for smooth insertion of the device, and ventilation through the device. These were head extension and ‘up-to-one-inch-out manoeuvres’. These two manoeuvres were required in all patients.

Airway Management in Athletes Wearing Lacrosse Equipment

Patient ventilation volume and rate have been found to be compromised due to the inability to seal a pocket mask over the chinstrap of football helmets. The effects of supraglottic airway devices such as the King LT and of lacrosse helmets on these measures have not been studied. To assess the effects of different airway management devices and helmet conditions on producing quality ventilations while performing cardiopulmonary resuscitation on simulation manikins. Crossover study. Simulation laboratory. Thirty-six athletic trainers (12 men, 24 women) completed this study. Airway-management device (pocket mask, oral pharyngeal airway, King LT airway [KA]) and helmet condition (no helmet, Cascade helmet, Schutt helmet, Warrior helmet) served as the independent variables. Participant pairs performed 2 minutes of 2-rescuer cardiopulmonary resuscitation under 12 trial conditions. Ventilation volume (mL), ventilation rate (ventilations/min), rating of perceived difficulty (RPD), and percentage of quality ventilations were the dependent variables. A significant interaction was found between type of airway-management device and helmet condition on ventilation volume and rate ( F12,408 = 2.902, P < .0001). In addition, a significant interaction was noted between airway-management device and helmet condition on RPD scores ( F6,204 = 3.366, P = .003). The no-helmet condition produced a higher percentage of quality ventilations compared with the helmet conditions ( P ≤ .003). Also, the percentage of quality ventilations differed, and the KA outperformed each of the other devices ( P ≤ .029). The helmet chinstrap inhibited quality ventilation (rate and volume) in airway procedures that required the mask to be sealed on the face. However, the KA allowed quality ventilation in patients wearing a helmet with the chinstrap fastened. If a KA is not available, the helmet may need to be removed to provide quality ventilations.

Are the King LTS Laryngeal Tube and the Ambu AuraOnce Laryngeal Mask Useful Airway Adjuncts for Military Medics?

Airway management is a critical skill that may be essential in the battlefield. The aim of this study was to determine if combat life savers and medics with no or limited clinical experience could provide airway control using the disposable laryngeal suction tube (LTS-D) and the Ambu® AuraOnce ™ disposable laryngeal mask (LMA). Eight military medics with limited clinical experience and no airway management experience secured the airway on 19 intrahospital anesthetized patients using the LTS-D and the LMA. Each patient was treated with both airway adjuncts in a randomized order. Each medic was studied on at least two and not more than three patients. Success of insertion, number of attempts, and time to correct placement with verified ventilation were recorded. When using the LTS-D, the first-attempt success rate for the medics with the first patient was 50% (four of eight) and 75% (six of eight) on the second attempt. With the second patient, the first-attempt success rate was 87.5% (seven of eight), and on the third patient, it was 100% (three of three). For all patients, the accumulated first-attempt success rate was 73.7% (14 of 19) and 84.2% (16 or 19) for second attempts with the LTS-D. The success rate on first attempt with the LMA was 100% (19 of 19) on the first patient. On the second intervention with the LMA, there was a significant decrease in mean time to verified ventilation, from 56.4 seconds to 27.7 seconds (ρ = .043), and time to verified ventilation with no leakage, from 61.3 seconds to 32.3 seconds (ρ = .029). Insertion attempts for three LTS-Ds and one LMA failed. This study suggests that for the safe use of the laryngeal tube suction by inexperienced airway providers, a clinical training program is required. The LMA proved superior to the LTS-D with a 100% success rate at the first attempt, which suggests that minimal training is needed before clinical use. We therefore recommend the LMA as the primary airway adjunct for military medics, despite a hypothetically inferior protection from aspiration.

A comparison between the Supreme laryngeal mask airway and the laryngeal tube suction during spontaneous ventilation: A randomized prospective study.

Background and Aims:The Supreme laryngeal mask airway (SLMA) and the laryngeal tube suction-disposable (LTS-D), both second-generation supraglottic airway devices, have a record of efficiency when used for airway management in mechanically ventilated patients, during general anesthesia. There is no published data comparing these two devices in patients breathing spontaneously during general anesthesia.Material and Methods:Eighty patients with normal airways undergoing elective general anesthesia with spontaneous ventilation were randomized to airway management with a SLMA or LTS-D. Efficacy and adequacy of oxygenation and ventilation were compared.Results:No cases of desaturation of oxygen saturation (SpO2) values of less than 95% occurred with either device. The mean difference for SpO2 between the two devices (0.7%) has no clinical significance. Slight hypercapnia was noted with both devices to acceptable values during spontaneous ventilation.Conclusions:Both SLMA and LTS-D are suitable and effective for airway management in patients breathing spontaneously during general anesthesia for minor surgery of short duration.

Comparison of Proseal Laryngeal Mask Airway and Endotracheal Tube for intubation in Paediatric Patients for Surgical Procedures of Short Duration

The laryngeal mask airway is a supraglottic device to secure the airway. Proseal laryngeal mask airway has several modification compared to the classic laryngeal mask airway with respect to a modified cuff design, gastric drainage tube placed lateral to main airway tube helps in passage of gastric contents and to prevent aspiration. This study was conducted to compare the efficacy of proseal laryngeal mask airway with the endotracheal tube in paediatric patients undergoing surgical procedures with respect to number of attempts of device placement, haemodynamic response and postoperative respiratory complication. 80 of patients ASA1 and 11 category of 2-8 years of age of weight 10-20 kg were randomly divided into two groups of 40 patients. The number of attempts of insertion of endotracheal tube is less than the proseal laryngeal mask airway. Significant changes in haemodynamic parameters were observed in the endotracheal tube group. The post-operative respiratory complication of cough and bronchospasm was found to be more in the endotracheal group. The proseal laryngeal mask airway produced more of soft tissue trauma. There were no significant difference in SPO2 and Etco2 levels between the two groups. There is no incidence of aspiration in either of group. It is concluded that proseal laryngeal mask airway can be used as a safe and effective alternative device to the endotracheal tube for the paediatric patients undergoing elective short duration procedure.

Efficiency and safety of the application of laryngeal tube iLTS-D in patients with uncomplicated airway. A pilot study

Efficiency and safety of the application of laryngeal tube iLTS-D in patients with uncomplicated airway. A pilot study

Effectiveness of Proseal laryngeal mask airway and laryngeal tube suction in elective non-laparoscopic surgeries of up to ninety minutes duration: A prospective, randomized study

Background and Aims:Proseal laryngeal mask airway (LMA) and laryngeal tube suction (LTS) are both supraglottic devices with an esophageal suction port. In the present prospective, randomized study, the effectiveness of airway seal, hemodynamic variables, ability to pass orogastric tube, and postoperative complications with the two devices were evaluated.Material and Methods:This was a prospective, randomized, single-blind study conducted in a hospital-based setting. Sixty patients (American Society of Anesthesiologists Grade I and II) undergoing elective general surgery were randomly allocated to Group A (Proseal LMA) or Group B (LTS), and airway seal pressure (primary outcome), peak pressure, hemodynamic parameters (blood pressure, pulse rate and pulse oximetry) during and 5 min after insertion, insertion time, ease of insertion, and postoperative complications (sore throat and hoarseness of voice for a period of 24 hours) (secondary outcomes) were noted. The quantitative data was summarized as mean and standard deviation, and analyzed using Student's t-test. All the qualitative data were summarized as proportions and analyzed using Chi-square test. The levels of significance and α-error were kept 95% and 5%, respectively, for all statistical analyses. P ≤ 0.05 was considered significant (S).Results:Proseal LMA had shorter insertion time (16.4 ± 5.6 vs. 20.0 ± 3.9 s), higher seal pressure (27.6 ± 4.6 vs. 24.1 ± 5.6 cm of H2O), lesser peak pressure (16.3 ± 2.3 vs. 18.5 ± 3.9 cm of H2O), higher success rate of orogastric tube passage (86.7 vs. 76.7%), and lesser postoperative sore throat (3.3 vs. 10%).Conclusions:Both Proseal LMA and LTS were acceptable alternatives for airway management in elective surgeries with controlled ventilation, but the quality of ventilation was found to be significantly better with Proseal LMA (in terms of higher seal pressure, lesser peak pressure, lesser insertion time, and lesser complications).

Advanced Airway Management for Traffic Accident Patients

This study aims to identify advantages in the speed and success rates of intubation with a supraglottic airway device and tracheal intubation into a simulated trauma patient in an automobile accident. Forty-two EMT-Paramedics (21 in LTS group, 21, in VL group) from Region “K” in Korea performed either laryngeal tube suction (LTS) using a supraglottic airway device (SAD) or tracheal intubation using a video laryngoscope (VL) on a manikin simulating a trauma patient in an overturned automobile, noting the success rate and speed. Among the two methods for advanced airway management used in the experiment, LTS using the SAD was found to have the fastest deployment speed; LTS was also found to have a higher degree of accuracy (p<.001). According to the study, the use of faster and more precise LTS is more effective for the airway management of emergency patients in an overturned vehicle.

Spinal movement and dural sac compression during airway management in a cadaveric model with atlanto-occipital instability.

To analyze the compression of the dural sac and the cervical spinal movement during performing different airway interventions in case of atlanto-occipital dislocation. In six fresh cadavers, atlanto-occipital dislocation was performed by distracting the opened atlanto-occipital joint capsule and sectioning the tectorial membrane. Airway management was done using three airway devices (direct laryngoscopy, video laryngoscopy, and insertion of a laryngeal tube). The change of dural sac's width and intervertebral angulation in stable and unstable atlanto-occipital conditions were recorded by video fluoroscopy with myelography. Three-dimensional overall movement of cervical spine was measured in a wireless human motion track system. Compared with a mean dural sac compression of -0.5mm (-0.7 to -0.3mm) in stable condition, direct laryngoscopy caused an increased dural sac compression of -1.6mm (-1.9 to -0.6mm, p=0.028) in the unstable atlanto-occipital condition. No increased compression on dural sac was found using video laryngoscopy or the laryngeal tube. Moreover, direct laryngoscopy caused greater overall extension and rotation of cervical spine than laryngeal tube insertion in both stable and unstable conditions. Among three procedures, the insertion of a laryngeal tube took the shortest time. In case of atlanto-occipital dislocation, intubation using direct laryngoscopy exacerbates dural sac compression and may cause damage to the spinal cord.