Page 95 - JSOM Summer 2018

TABLE 2 Attempt Needed for Successful Intervention Depending on TABLE 3 Timing for All Airway Interventions (Seconds)
the Ratio of Interventions (Patients) Performed Intervention Total Minimum Maximum Mean
LTS-D LMA LMA
Successful/ Successful/
Unsuccessful Unsuccessful Time to correct placement 18 5 55 17.5
Interventions, No. Interventions, No. Time to ventilation 18 7 68 28.3
Medics (n = 8) Verified ventilation 18 16 120 44.3
Attempt 1 4 8 Verified ventilation with
Insertion 1, Attempt 2 6 — no leakage 18 16 120 48.3
No success 2 —
Medics (n = 8) LTS-D
Attempt 1 7 7 Time to cuff 16 19 74 37.1
Insertion 2, Attempt 2 — — Time to ventilation 16 25 88 46.1
No success 1 1
Verified ventilation 16 33 132 58.7
Medics (n = 3) Verified ventilation with
Attempt 1 3 3 no leakage 16 33 154 60.1
Insertion 3, Attempt 2 — —
No success — —
Medics (n = 19) Complications reported were blood on the LTS-D during re-
Attempt 1, n (%) 14 (73.7) 18 (94.7) moval (n = 2) and violaceous color of the tongue within 3 min-
Insertion 1–3, 16 (84.2) — utes after intervention (n = 1). In one of the bleeding patients,
Attempt 2, n (%) it was possible to see blood sieving in the oropharynx where
No success, n (%) 3 (15.8) 1 (5.3) the tip of the LTS-D had caused trauma on insertion. One air-
way obstruction was reported with the LTS-D necessitating
The mean propofol dose given during the airway intervention replacement with an LMA.
was 5.42mg/kg (range, 2.79–11.52 mg/kg). Cuff pressure was
recorded for 11 of 19 patients. The mean cuff pressure was
103.6mmHg (range, 40–140mmHg). The cuff volume of the Discussion
LTS-D was recorded for 16 patients; the mean volume was The military medic has a special scope of practice. With mini-
78.1mL (range, 50–80mL). In 14 patients in whom the size mal experience, and just after receiving basic medical training,
4 LTS-D was used, the volume of air in the cuff was 80mL; they can deploy to a potentially hostile environment where
according to the manufacturer, it should be 50–70mL. they are required to perform lifesaving airway maneuvers. It
can also be that the rate of deployment is so high that the med-
Complications ic’s medical knowledge is out of date and the time for updating
In seven of 19 interventions (36%) with the LTS-D, medics their training and clinical skills is limited. We wanted to find
reported difficulty (including the successful intubations) pass- evidence of an adjunct that would make the airway manage-
ing the oropharynx. For all the failed intubations with the ment easier for the environments and conditions applicable to
LTS-D (n = 3) and LMA (n = 1), the medics and research team the medic’s scope of practice. It should be easy to handle, have
members reported that the tube (or mask) came to a stop in a high rate of success, small risk of complications, and require
the oropharynx, and although rigorous airway manipulation a small amount of training and clinical skills.
was used, they could not pass the adjunct down to the hy-
popharynx. Other difficulties reported were difficulty pass- The LTS-D predecessor, the LT, had proved to be a reliable
ing the incisors (n = 1) and the patient was too superficially airway adjunct in the intrahospital 22,27–29 and the prehospital
anesthetized. settings. 21,31 There was also a study that reported an insertion

TABLE 4 Mean Insertion Times and Significance Related to Number of Airway Interventions and Experience Gained
Intervention No. No. Mean (s) Standard Deviation p
1 8 16.50 10.994 .656
LMA time to correct placement
2 7 14.43 5.062
1 8 30.63 17.920 .191
LMA time to ventilation
2 7 21.00 6.557
1 8 56.38 32.780 .043
LMA verified ventilation
2 7 27.71 5.794
1 8 61.25 29.504 .029
LMA verified ventilation with no leakage
2 7 32.29 10.594
1 6 33.33 10.113 .471
LTS-D time to cuff
2 7 38.57 14.386
1 5 41.60 10.040 .419
LTS-D time to ventilation
2 7 47.29 12.406
1 5 61.40 39.696
LTS-D verified ventilation
2 7 58.00 15.790 .839
1 5 65.80 49.489
LTS-D verified ventilation with no leakage
2 7 58.00 15.790 .700
Data in bold are statistically significant.

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