Prehospital airway management using the laryngeal tube An emergency department point of view

• Published in: Der Anaesthesist Vol. 63; no. 7; pp. 589 - 596
• Main Authors: Bernhard, M., Beres, W., Timmermann, A., Stepan, R., Greim, C.-A., Kaisers, U.X., Gries, A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2014
• Subjects: Accidental Falls; Accidents, Traffic; Adult; Aged; Airway Management - adverse effects; Airway Management - methods; Anesthesiology; Critical Care Medicine; Emergency Medical Services - methods; Emergency Medicine; Emergency Service, Hospital; Female; Glasgow Coma Scale; Heart Arrest - therapy; Humans; Intensive; Intubation, Intratracheal - adverse effects; Intubation, Intratracheal - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Motorcycles; Notfallmedizin; Out-of-Hospital Cardiac Arrest - therapy; Pain Medicine; Young Adult; Rettungsdienst; Nebenwirkungen; Beatmung, künstlich; Professional competence; Endotracheale Intubation; Emergency medical service; Professionelle Kompetenz; Adverse effect; Endotracheal intubation; Respiration, artificial
• ISSN: 0003-2417; 1432-055X
• DOI: 10.1007/s00101-014-2348-1

Background Competence in airway management and maintenance of oxygenation and ventilation represent fundamental skills in emergency medicine. The successful use of laryngeal tubes (LT, LT-D, LTS II) to secure the airway in the prehospital setting has been published in the past. However, some complications can be associated with the use of a laryngeal tube. Methods In a nonconsecutive case series, problems and complications associated with the use of the laryngeal tube in prehospital emergency medicine as seen by independent observers in the emergency room are presented. Results Various problems and possible complications associated with the use of a laryngeal tube in eight case reports are reported: incorrect placement of the laryngeal tube in the trachea, displacement and/or incorrect placement of the laryngeal tube in the pharynx, tongue and pharyngeal swelling with subsequently difficult laryngoscopy, and inadequate ventilation due to unrecognized airway obstruction and tension pneumothorax. Conclusion Although the laryngeal tube is considered to be an effective, safe, and rapidly appropriable supraglottic airway device, it is also associated with adverse effects. In order to prevent tongue swelling, after initial prehospital or in-hospital placement of laryngeal tube and cuff inflation, it is important to adjust and monitor the cuff pressure. Article in English.