Airway management techniques in a restricted-access situation: a manikin study

Background: Access to patients can be restricted in emergency situations. A variety of techniques and devices are available for use in patients who require oxygenation in a restricted-access situation. Objectives: The aim of this study was to investigate whether there is one ventilation technique that is superior to others. Materials and methods: Fifty-four emergency medical services providers including emergency medical technicians, paramedics and physicians were asked to use a bag-valve mask (BVM), a laryngeal mask airway (LMA), and a laryngeal tube (LT) to ventilate a full-scale manikin sitting upright in the driver’s seat of a motor vehicle. Access to the manikin was gained through the side window and from the backseat. Results: There were significant differences in time to first successful ventilation between the two approaches for access to the airway. The fastest median time to ventilation was obtained with the BVM (7 and 8 s), followed by the LT (13 and 14 s) and the LMA (15 s for both types of access). Overall success rates were 97.2% for the BVM, 96.3% for the LMA, and 100% for the LT. Most participants needed two attempts for each device. There were no significant differences between participants depending on the level of qualification or professional experience. The BVM was rated the lowest and the LT was rated the highest for ease of use. Conclusion: Supraglottic airway devices appear to offer advantages in restricted-access situations.

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