Research Article

Comparison of the Skill of Emergency Medical Technicians in Terms of Advanced Airway Management Using Endotracheal Tube versus Laryngeal Mask Airway in an OSCE Using a Mannequin


Background: Supraglottic airway management tools such as the laryngeal mask airway (LMA) have recently emerged as the first choice in pre-hospital and hospital airway management guidelines as well as an alternative strategy after endotracheal tube (ETT) placement failure. However, the pros and cons of the LMA compared to endotracheal intubation are still debated.
Given that no study has been conducted to date on the skills of emergency medical technician (EMT) in airway management using LMA compared to endotracheal intubation, we decided to do a study in this regard.
Methods: In this objective structured clinical examination (OSCE), EMTs who had a degree of associate or bachelor were participated. The examiner asked the examinees the required information and entered it in the pre-prepared checklists. The participants took part in a two-stage exam. In the first stage, the airway management of the simulated trauma patient was performed by endotracheal intubation, and in the second stage, the same scenario was performed with LMA. At each stage, the examiner evaluated the examinee's performance in 4 fields of Preparation, Pre-oxygenation, Position and Placement, and Post-intubation management using a standard checklist. In addition, the duration of the procedure from the beginning to the time of fixing the ETT or LMA was recorded and compared.
Results: Totally, 105 EMTs participated in this study, of whom, 102 were male (97.1%). The mean age of the subjects was 36.4± 7.3 years old. Of the total participants, 72 passed both practical exams successfully, and they generally insert the LMA faster; so that the duration of intubation and LMA insertion in 1.4% and 30.6% were <1 min, respectively (p< 0.001). However, no significant difference was observed in terms of the mean time (p= 0.427).
Conclusion: In the present study, the skills of the technicians participating in the study in performing advanced airway procedures were moderate, and also, it was found that their skills in LMA insertion were less than endotracheal tube insertion.

[1] Motamedi M, Soltani M, Amiri M, Memary E. The Relationship between Orotracheal Intubation Difficulty Scoring Systems and Anthropometric Factors. Advanced journal of emergency medicine. 2019;3(1):e5.
[2] Hilker T, Genzwuerker HV. Inverse intubation: an important alternative for intubation in the streets. Prehosp Emerg Care. 1999; 3(1):74-6.
[3] Lockey D, Healey B, Crewdson K, Chalk G, Weaver A, Davies G. Advanced airway management is necessary in prehospital trauma patients. Br J Anaesth. 2014; 114(4):657-62.
[4] Sise MJ, Shackford SR, Sise CB, Sack DI, Paci GM, Yale RS, et al. Early intubation in the management of trauma patients: indications and outcomes in 1,000 consecutive patients. J Trauma. 2009; 66(1):32-9.
[5] Komatsu R, Kasuya Y, Yogo H, Sessler DI, Mascha E, Yang D, et al. Learning Curves for Bag-and-mask Ventilation and Orotracheal IntubationAn Application of the Cumulative Sum Method. Anesthesiology. 2010; 112(6):1525-31.
[6] Bernhard M, Mohr S, Weigand M, Martin E, Walther A. Developing the skill of endotracheal intubation: implication for emergency medicine. Acta Anaesthesiol Scand. 2012; 56(2):164-71.
[7] Katz SH, Falk JL. Misplaced endotracheal tubes by paramedics in an urban emergency medical services system. Ann Emerg Med. 2001; 37(1):32-7.
[8] Herff H, Wenzel V, Lockey D. Prehospital intubation: the right tools in the right hands at the right time. Anesth Analg. 2009; 109(2):303-5.
[9] Davis DP, Hoyt DB, Ochs M, Fortlage D, Holbrook T, Marshall LK, et al. The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury. J Trauma. 2003; 54(3):444-53.
[10] Cook T, Woodall N, Frerk C, Project FNA. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011; 106(5):617-31.
[11] Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004; 99(2):607-13.
[12] Jaber S, Amraoui J, Lefrant J-Y, Arich C, Cohendy R, Landreau L, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med. 2006; 34(9):2355-61.
[13] Truhlar A, Ferson DZ. Use of the Laryngeal Mask Airway Supreme in pre-hospital difficult airway management. Resuscitation. 2008; 78(2):107-8.
[14] Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, et al. European resuscitation council guidelines for resuscitation 2010 section 4. Adult advanced life support. Resuscitation. 2010; 81(10):1305-52.
[15] Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airwayan updated report by the American Society of Anesthesiologists task force on management of the difficult airway. Anesthesiology. 2013; 118(2):251-70.
[16] Lockey D, Crewdson K, Davies G, Jenkins B, Klein J, Laird C, et al. AAGBI: Safer pre‐hospital anaesthesia 2017: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2017; 72(3):379-90.
[17] Seung HY, Beirne OR. Laryngeal mask airways have a lower risk of airway complications compared with endotracheal intubation: a systematic review. J Oral Maxillofac Surg. 2010; 68(10):2359-76.
[18] Woodall N, Cook T. National census of airway management techniques used for anaesthesia in the UK: first phase of the Fourth National Audit Project at the Royal College of Anaesthetists. Br J Anaesth. 2010; 106(2):266-71.
[19] Benger JR, Kirby K, Black S, Brett SJ, Clout M, Lazaroo MJ, et al. Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomized clinical trial. JAMA. 2018; 320(8):779-91.
[20] Länkimäki S, Alahuhta S, Silfvast T, Kurola J. Feasibility of LMA Supreme for airway management in unconscious patients by ALS paramedics. Scand J Trauma Resusc Emerg Med. 2015; 23(1):24.
[21] Bosch J, De Nooij J, De Visser M, Cannegieter S, Terpstra N, Heringhaus C, et al. Prehospital use in emergency patients of a laryngeal mask airway by ambulance paramedics is a safe and effective alternative for endotracheal intubation. Emerg Med J. 2014; 31(9):750-3.
[22] Farhadloo R, Kashaninejad M, Hasanpour L, Vahedian M, Darebaghi H, Asayesh H, et al. A Comparison of Insertion and Success Rate in the Use of Two Methods of Endotracheal Intubation and Laryngeal Mask Airway. Qom Univ Med Sci J. 2016; 10(10):34-40.
IssueVol 6 No 4 (2020): Autumn QRcode
SectionResearch Article(s)
Emergency medical services Emergency medical technicians Intubation Intratracheal Laryngeal masks Manikins

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How to Cite
Saberian P, Karimialavijeh E, Sadeghi M, Rahimi M, Hasani-Sharamin P, Sotoodehnia M. Comparison of the Skill of Emergency Medical Technicians in Terms of Advanced Airway Management Using Endotracheal Tube versus Laryngeal Mask Airway in an OSCE Using a Mannequin. Arch Anesth & Crit Care. 2020;6(4):167-174.