The intubating laryngeal mask: Use of a new ventilating-intubating device in the emergency department

The intubating laryngeal mask airway (ILM) was introduced in 1997 as a modi fication of the classic laryngeal mask airway. In addition to serving as an elective or emergency ventilating device, it is designed to allow blind in tubation. We report 3 cases of airway management in the emergency departmen t of Yale-New Haven Hospital where the ILM was used to establish ventilatio n and intubation in patients in whom direct laryngoscopy had failed. The 3 cases are representative of situations commonly seen in the ED: the obtunde d and apneic ("crash airway") patient, failed rapid sequence intubation, an d the recognized difficult airway/awake intubation. In all 3 cases, a clear airway was established on initial placement of the ILM, and intubation was achieved on the first attempt at blind advancement of the endotracheal tub e. Although the ILM may be an important addition to the armamentarium of th e emergency physician, proficiency in its use requires practice under contr olled conditions. We suggest that the emergency physician seek out elective practice in either a teaching workshop or hospital operating theater.