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Rescue intubation through supraglottic airways

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Ross Hofmeyr

on 9 March 2018

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Transcript of Rescue intubation through supraglottic airways

Rescue intubation through
supraglottic airway devices

SGAs for Blind Intubation
Success in rates in the literature
First time vs. multiple attempts:

ILMA 70-92% vs. 91-99%
i-Gel 40-69% vs. 73%
Air-Q <57-70% vs. 47-77%
Elisha 75% vs. 85%
CobraPLUS ?? vs. 47%
"Piggybacked" onto 3gLM vs ProSeal study
Randomized to Rusch or Parker Flex-Tip ETT

Single blinded 'fibreoptic observed' attempt
No special positioning or manipulation

Confirmation by FO, ventilation and EtCO2
Fibreoptic inspection before and after for trauma due to intubation

Results: Blind Intubation
Success rate for single intubation attempt:
Overall: 76% (47/62)
Rusch ETT: 67% (20/30)
Parker ETT: 88% (28/32)

No trauma (84% no change; 16 % erythema)

No difference in side-effects/complications
3gLM Trial Conclusions
Effective LMA for normal airways

Good device for blind intubation, outperforming other SGAs

Further study needed to compare directly with Fastrach ILMA

Great potential as a rescue airway and where conversion to ETT may be needed
Dept Anaesthesia & Critical Care, University of Cape Town
Groote Schuur and Red Cross War Memorial Children's Hospitals
Gold standard =
Dr Ross Hofmeyr, MBChB (Stell) DipPEC, DA (SA)
Take Home Messages
SGAs are well proven as rescue airways

Intubation can be visually guided or blind

Visually guided techniques require additional skills and equipment

Current gold standard for blind intubation through SGA is the ILMA

3gLM very promising; needs more hard data
What's all the Fuss?
3rd generation laryngeal mask
"Self-energising" peripharyngeal seal
Double gastric drainage ports
"Reservoir" capability
Large-bore airway
Structure directs ETT
Why SGA?
Evidence for SGA as airway rescue
Which device? (classify?)
Available techniques (visual or blind)
Visual - CTrach, fibreoptic, Ascope, video, rigid endoscope
Blind - device or bougie
Bougie - evidence?
Device - success rates in literature
Fastrach ILMA
3gLM trial methods
3gLM trial results
Contrast with existing data
Prospectives for future research

Results: 3gLM as a SGA
Flexible or
rigid scope
Video iLMA
Blind using bougie
Blind using intubating SGA
Blind Bougie
3gLM Intubation Trial
No conflicts of interest to declare

(I just love playing with toys)
Good summary
Contact me!
www.wildmedic.co.za/presentations ross@wildmedix.com
Full transcript