Comparison of placement of the laryngeal mask airway with endotracheal tube by paramedics and respiratory therapists.

STUDY OBJECTIVE: To determine the learning curve of nonphysician emergency personnel on placement of the laryngeal mask airway as compared to performance of endotracheal intubation.

DESIGN: Prospective, comparative, randomized, patient-blinded trial.

SETTING: Regional hospital operating room.

PARTICIPANTS: Seven experienced paramedics and 12 respiratory therapists trained in endotracheal intubation.

INTERVENTIONS: Patients used as subjects were anesthetized and paralyzed. Each participant then performed placement of both the laryngeal mask airway and endotracheal tube on the same patient in random sequence. Both techniques were observed for speed, difficulty, and effectiveness.

MEASUREMENTS AND MAIN RESULTS: The techniques were timed from the point at which the participant touched the patient to the time they were able to effectively ventilate the patient. Participants also were asked to rate the difficulty of each technique on a 100-mm visual analog score. Failure (three attempts without successful ventilation) rates also were monitored. The mean time to ventilate successfully with the laryngeal mask airway was significantly less than that with the endotracheal tube (38.9 +/- 1.9 seconds versus 206.1 +/- 31.9 seconds, P < .0001). The average number of attempts was 1.0 +/- 0.0 for the laryngeal mask airway and 2.22 +/- 0.21 for the endotracheal tube (P < .01). No one failed to place the laryngeal mask airway; and ten of 19 (52.6%, P < .01) failed to perform endotracheal intubation. The endotracheal tube had a significantly higher rating of difficulty than did the laryngeal mask airway (67.3 versus 8.64, P < .0001).