Laryngeal tube suction for airway management during in-hospital emergencies

• Published in: Clinics (São Paulo, Brazil) Brazil), 2017-07, Vol.72 (7), p.422-425
• Main Authors: Mutlak, Haitham, Weber, Christian Friedrich, Meininger, Dirk, Cuca, Colleen, Zacharowski, Kai, Byhahn, Christian, Schalk, Richard
• Format: Article
• Language: English
• Subjects: Cardiopulmonary Resuscitation - methods; Clinical Science; Difficult Airway Management; Emergencies; Female; Humans; In-Hospital Emergencies; Intubation, Intratracheal - methods; Laryngeal Tube; Male; MEDICINE, GENERAL & INTERNAL; Middle Aged; Respiration, Artificial; Suction; Supraglottic Airway Devices; Time Factors
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.6061/clinics/2017(07)06

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. 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. 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. 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.