LMA not always successful; needle crike fails often

A meta-analysis of pre-hospital airway control techniques evaluated alternative techniques to tracheal intubation. The outcome was placement success; there were no data on effectiveness of ventilation or other clinical outcomes. Although limited by poor quality studies, there are some interesting findings.

The pooled placement success rates for Combitube and LMA, were similar but unimpressive, with nonphysician placement success rates of 83.0% and 82.7%, respectively. The authors point out that while these devices might offer potential advantages over conventional tracheal intubation in terms of reduced training requirements, or perhaps fewer or less severe complications, they should not be expected to provide higher airway management success rates than conventional tracheal intubation.

Low success rates for this 'rescue procedure'. Just get your scalpel...

They identified only four studies reporting the success rates of needle cricothyroidotomy (NC). Regardless of patient circumstances or clinician credentials, the NC success rate was ubiquitously low, ranging from 25.0% to 76.9%. The pooled results for the 18 surgical cricothyroidotomy (SC) studies produced substantially higher success rates, although the success rate for all nonphysician clinicians was still only 90.4%. The authors state: “EMS systems that choose to incorporate a percutaneous airway procedure into their airway management protocols should recognize that the success rate of SC far exceeds that of NC”.

A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates
Prehosp Emerg Care. 2010 Oct-Dec;14(4):515-30

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