Management of the difficult airway - An evaluation of alternative devices in the German emergency medical services

ummary: For the management of difficult and failed airway patients various alternative tools can be used to afford effective assisted ventilation. The aim of the study was to evaluate which alternatives were applied by German emergency medical services. Methods: Emergency physicians were contacted by email using databases of the German Association for Emergency Physicians BAND as well as non-profit organisations providing emergency medical services in Germany. The physicians were asked to complete a standardized questionaire investigating the preferred alternatives to endotracheal intubation in emergency situations. Results: 53.8% of the 593 physicians worked in tertiary medical centers, 67.3% were board-certified anaesthesiologists. 64% had professional experience of more than 5 years. 51.8% of the emergency ambulances run with emergency physicians were equipped with the laryngeal mask (LMA Classic), 9.4% with the ILM Fastrach(R), 5.0% with the LMA ProSeal, 40.1% with the esophagotracheal combitube, and 12.1% with the laryngeal tube. A high proportion of the emergency physicians had previous hands-on experience with the LMA classic (80.6%). The preferred alternative to endotracheal intubation in emergency situations were insertion of the laryngeal mask in 77.3%, the combitube in 68.1%, and the ILM Fastrach(R) in 48.1%. Conclusions: For the management of difficult and failed airway patients in emergency situations the emergency physicians of German emergency services consider the use of a laryngeal mask more recommendable than the use of a combitube or a laryngeal tube to achieve safe airway and ventilation. However in view of the positive assessment of the laryngeal tube such equipment should be more often available in ambulances.