Combat trauma airway management: Endotracheal intubation versus laryngeal mask airway versus combitube use by navy SEAL and Reconnaissance combat corpsmen

Background: Airway management takes precedence regardless of what type of l ife support is taking place. The gold standard for airway control and venti lation in the hands of the experienced paramedic remains unarguably the end otracheal tube. Unfortunately, laryngoscopy and endotracheal intubation req uire a skilled provider who performs this procedure on a frequent basis. Sp ecial Operations corpsmen and medics receive training in the use of the end otracheal tube, but they use it infrequently. The use of alternative airway s by Navy SEAL and Reconnaissance combat corpsmen has not been evaluated, O ur objective was to compare the ability of Special Operations corpsmen to u se the endotracheal tube (ETT), laryngeal mask airway (LMA), and esophageal -tracheal combitube (ETC) under combat conditions. Methods: This study used a prospective, randomized, crossover design. Twelv e Navy SEAL or Reconnaissance combat corpsmen participated in a 2-week Adva nced Battlefield Trauma course. During the first week, instruction included the use of ETT, LMA, and ETC, viewing of videotapes far ETC and LMA, and m annequin training. The Special Operations corpsmen were required to reliabl y insert each airway within 40 seconds. During the second week, participant s dealt with a number of active combat trauma scenarios under fire in comba t conditions. Each SEAL or Reconnaissance corpsman was asked to control his "casualty's" airway with a randomized device. All participants were evalua ted in the use of each of the three airways. Results: Thirty-six airway insertions were evaluated, No failures occurred. All incorrect placements were detected and corrected. Mean time to place t he ETT was 36.5 seconds versus 40.0 seconds for the ETC. The LMA insertion time of 22.3 seconds was significantly shorter than the other times (p < 0. 05), The mean number of attempts per device was similar with all devices: L MA (1.17), ETC (1.17), and ETT (1.25), Conclusion: The Special Operations corpsmen easily learned how to use the E TC and LMA, In this study, they showed the ability to appropriately use the ETT as well as the ETC and LMA, For SEAL corpsmen, the alternative airways should not replate the ETT; however, on occasion an advanced combat casual ty care provider may not be able to use the laryngoscope or may be unable t o place the ETT, The LMA and ETC are useful alternatives in this situation. If none of these airways are feasible, cricothyrotomy remains an option. R egardless of the airway device, refresher training must take place frequent ly.