From the Guidelines
Emergency Medical Services (EMS) providers should be proficient in using blind insertion airway devices (BIADs), such as the King Laryngeal Tube, Laryngeal Mask Airway (LMA), and Combitube, as they provide effective airway management when endotracheal intubation is not possible or appropriate. These devices are inserted without direct visualization of the vocal cords and create a seal that allows for ventilation 1. The King LT is particularly popular in EMS settings due to its ease of insertion and effectiveness; it comes in various sizes based on patient height and has a dual-lumen design with balloons that create seals in the esophagus and oropharynx. The LMA forms a seal around the laryngeal inlet and is available in multiple sizes based on patient weight. The Combitube is a dual-lumen tube that can function whether placed in the esophagus or trachea.
Key Characteristics of BIADs
- Inserted without direct visualization of the vocal cords
- Create a seal that allows for ventilation
- Require less training than endotracheal intubation
- Can be placed rapidly
- Don't require specialized equipment
Importance of BIADs in EMS
BIADs are valuable because they provide effective airway management in emergency situations where securing an airway quickly is critical 1. They are particularly useful when endotracheal intubation is not possible or appropriate, and can be used as an alternative to bag-mask ventilation for well-trained healthcare providers who have sufficient experience to use the devices for airway management during cardiac arrest (Class IIa, LOE B) 1.
Proper Use of BIADs
When using any BIAD, providers should:
- Lubricate the device
- Position the patient's head properly
- Insert the device according to manufacturer guidelines
- Inflate the cuff(s)
- Confirm placement through chest rise, breath sounds, and end-tidal CO2 monitoring
- Secure the device
By following these guidelines and using BIADs effectively, EMS providers can provide high-quality airway management and improve patient outcomes in emergency situations.