Initial experience of emergency physicians using the intubating laryngeal mask airway: A case series

Objective: Although the intubating laryngeal mask airway (ILMA) is widely a vailable, its use by emergency physicians (EPs) has not been reported. The authors report the initial experience of EPs using the ILMA. A review of th eir experience and the relevant anesthesia literature provides a basis for EPs to use the ILMA more confidently and effectively. Methods: Between Janu ary 2000 and January 2001, the ILMA was used on a convenience sample of eme rgency department (ED) patients undergoing "routine" intubations, and "resc ue" situations, after failed rapid-sequence intubation (RSI). Patients were identified from the ED resuscitation case database. Chart review and intub ating physician interviews focused on success of the device, complications encountered, and "pearls" of the device's use as perceived by the intubatin g physician. Results: Ventilation with the appropriate-size ILMA occurred i n less than 15 seconds in all "routine" intubations; tracheal intubation wa s subsequently accomplished in less than 1 minute. Eight of nine "routine" patients had blind tracheal intubation through the ILMA. One patient requir ed fiberoptic bronchoscopy to guide the endotracheal tube into the trachea. Of the "rescue" intubations, all patients (n = 7) were successfully ventil ated and five were successfully intubated using the ILMA. Conclusions: In t his case series, the ILMA was easy to use in acute resuscitations, and prov ed to be invaluable in cases of failed RSI.