Can Emergency Medical Services Personnel Effectively Place and Use the Supraglottic Airway Laryngopharyngeal Tube (SALT) Airway??

Background. Various alternative airway devices have been developed in the last several years. Among these is the Supraglottic Airway Laryngopharyngeal Tube (SALT), which was designed to function as a basic mechanical airway and as an endotracheal tube (ET) introducer for blind endotracheal intubation (ETI). Objective. To determine the rate of successful placement of the SALT and the success rate of subsequent blind ET insertion by a cohort of emergency medical services (EMS) providers of varying levels of EMS certification. Methods. This study was a two-phase, two-group nonblinded, prospective time trial using a convenience cohort of prehospital providers to determine the success rate for SALT placement (i.e., the basic life support [[BLS]] phase) and ET placement using the SALT (i.e., the advanced life support [[ALS]] phase) in an unembalmed human cadaver model. The part 1 cohort (group 1) comprised predominantly basic and intermediate emergency medical technician (EMT)-level providers, whereas the part 2 cohort (group 2) comprised exclusively paramedic-level providers. Results. In group 1, 51 (98%%) of the subjects were able to successfully place the SALT and ventilate the cadaver (BLS phase), with 48 (92.3%%) subjects successfully placing it on the first attempt. In group 2, 21 (96%%) of the subjects were able to successfully place the SALT, with 19 (86%%) placing the SALT on the first attempt. Successful blind placement of an ET through the SALT (ALS phase) by group 1 was 48.1%% (95%% confidence interval [[CI]]: 34--62), with 37%% (95%% CI: 24--51) placing the ET on the first attempt. In group 2, 20 subjects (91%% [[95%% CI: 71--99]]) were able to successfully place an ET through the SALT, with 13 (59%% [[95%% CI: 36--79]]) doing so on the first attempt. Conclusions. Emergency medical services providers of varying levels can successfully and rapidly place the SALT and ventilate a cadaver specimen. The success rate for blind placement of an ET through the SALT was suboptimal.