Evaluation of standard endotracheal intubation, assisted laryngoscopy (airtraq), and laryngeal mask airway in the management of the helmeted athlete airway: A manikin study

Objectives: Physicians at sporting events must rarely manage the airway of a helmeted athlete. This poses challenges for providers who do not regularly engage in airway management. In a manikin model, our purpose was to determine (1) if standard endotracheal intubation (ETI) of a simulated helmeted athlete is adversely affected by bright-light conditions and (2) if the use of laryngeal mask airway (LMA) or Airtraq improves airway management success. Design: This is a randomized, prospective, crossover study. Setting: The study was conducted at a 500-bed community-based hospital with residency training programs in family medicine and emergency medicine, as well as a fellowship in sports medicine. PARTICIPANTS:: We randomized 42 residents to manage the airway of a simulated helmeted athlete in c-spine immobilization using ETI, Airtraq, and LMA. Each method was attempted under bright light and in standard light. Main Outcome Measures: Our main outcomes were success or failure of airway and time to airway. Secondary outcome was perceived difficulty in airway management as a factor of environmental factors. Results: Airway success rates were 93% for ETI, 99% for LMA, and 75% for Airtraq. Standard ETI was significantly faster than intubation using the Airtraq (P = 0.0001) and had greater success (P = 0.004). Time to airway was faster with LMA than with standard ETI (P < 0.00001). There was no impact of bright light on ETI time (P = 0.61). Conclusions: These results suggest that both ETI and LMA may be acceptable choices for management of the airway in the helmeted athlete. Time to airway was significantly decreased with the use of LMA, regardless of the experience level of the intubator. Lighting conditions had no effect on success.