Page 13 - JSOM Spring 2025

The Use of Different Types of Supraglottic Airway Devices

by Medics on a Manikin with Night Vision Goggles

A Pilot Study

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Christoph Jänig, MD, PhD *; Thomas Hummel, MD ; Manfred Berres, PhD ;
Arnulf Willms, MD, PhD ; Tim Piepho, MD, PhD 5
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ABSTRACT
Introduction: Under normal conditions, the use of a supraglot- Keywords: airway management; laryngeal mask airway; TCCC;
tic airway device (SAD) is safe and effective. There are situa- night vision goggles; resuscitation
tions in military environments in which such devices must be
used in the dark (e.g., to conceal the team’s position). The aim
of our study was to evaluate the use of different SADs using Introduction
night vision goggles (NVG) on a manikin. Methods: A group
of 53 medically trained soldiers (paramedics, emergency med- Until recently, military medical personnel have usually been
ical technicians [EMTs] and Combat First Responders Bravo) required to provide care under “tactical conditions.” Although
was given a brief demonstration of how to place three differ- terrorist attacks are not an invention of the 21st century, the
ent types of SAD in a manikin’s airway. This was followed by increase in assaults around the world has brought tactical op-
randomized use in ambient light and then, after the room was erating conditions to civilian rescue services more often.
darkened, with NVG. Differences in terms of placement suc-
cess, placement time, and observed usage problems were com- Noise, darkness, and dynamic changes in these situations are
pared. Results: Attempt success rates were >91% for all SADs but a few characteristics of this field of medical care. In ad-
used both in ambient light and with NVG. Median placement dition, specific injury patterns such as maxillofacial injuries,
times differed significantly between ambient light and NVG penetrating neck and chest wounds, and traumatic brain in-
(ambient light/NVG: i-gel, 7.2/15.1s; standard laryngeal mask juries are seen, and the resulting compromised airways have
airway [LMA], 15.4/21.5s; laryngeal tube [LT], 13.4/24.3s). established the need for leveraging technologies to improve the
In the direct comparison of the various SADs, the i-gel laryn- quality of care under these difficult circumstances.
geal mask airway was placed significantly faster than a stan-
dard LMA (P<.0001) and the LT (P<.0001). Conclusions: Our Beside the focus on best care for the patient and patient’s safety
study proves that the use of NVG has a measurable impact during all procedures under tactical conditions, the safety of
on the speed of placement but does not prolong placement to the care provider and other team members is also essential, for
a clinically significant extent on a manikin. In addition, there example, by maintaining a concealed position.
was no significant difference in the placement success for each
SAD in ambient light or with NVG. Furthermore, all partic- Tactical Combat Casualty Care (TCCC) was developed in
ipants were able to read the size information on the various the 1990s from the existing trauma algorithms of Advanced
SADs when wearing NVG and were thus able to make a proper Trauma Life Support (ATLS) and Pre-hospital Trauma Life
size selection. It would, however, make use easier if additional Support (PHTLS) to help with such situations. Airway man-
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size markings were added. SADs can be applied quickly and agement is one of the core aspects of TCCC and ranges from
safely on the manikin even when NVG are worn. Differences the application of basic measures like the jaw thrust maneuver
in the use of the various types of SAD are not relevant from a through to the use of nasopharyngeal airways and supraglottic
clinical perspective. Using NVG while placing a SAD seems to airway devices as well as surgical cricothyrotomy. 2
be safe for the patient and might increase safety for the care
provider in tactical situations by maintaining concealment in As in all other emergency situations, the aim is to prevent
dark environments. potentially avoidable deaths by ensuring a patent airway for
*Correspondence to Christoph Jänig, Bundeswehr Central Hospital, Department of Anaesthesia and Intensive Care Medicine, Ruebenacher Str.
170, 56072 Koblenz, Germany or Christoph.jaenig@gmail.com
1 CDR Christoph Jänig is senior consultant and head of EMS of the Department of Anaesthesia and Intensive Care Medicine, Bundeswehr Central
Hospital, Koblenz, Germany. MAJ Thomas Hummel is emergency physician in the Medical Coy of the Airborne Regiment 31, Seedorf, Germany.
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3 Dr. Manfred Berres is statistical consultant of the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Division of Medical
Biometry, Medical School of the Johannes Gutenberg University, Mainz, Germany, and is retired professor at the University of Applied Sciences
Koblenz, Department Mathematics and Technology, Remagen, Germany. LTC Arnulf Willms is senior consultant in the Department of Visceral
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Surgery, Bundeswehr Central Hospital, Koblenz, Germany. Dr. Tim Piepho is head of the Department of Anaesthesiology, Brothers of Mercy
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Hospital, Trier, Germany.
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