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CRITICAL CARE AND TRAUMA

Effects of a Suction Laryngoscope in a Model with Simulated Severe Airway Hemorrhage

Thomas Mitterlechner, MD^*, Nicolas Nerbl^*, Holger Herff, MD^*, Peter Paal, MD^*, Martin Moritz, MD^*, Frank Kloss, MD, Karl H. Lindner, MD^*, and Volker Wenzel, MD, MSc^*

From the Departments of *Anesthesiology and Critical Care Medicine, and Cranio-Maxillofacial and Oral Surgery, Innsbruck Medical University, Innsbruck, Austria.

Address correspondence and reprint requests to Dr. Thomas Mitterlechner, Innsbruck Medical University, Department of Anesthesiology and Critical Care Medicine, Innsbruck, Austria. Address e-mail to Thomas.Mitterlechner{at}i-med.ac.at.

In severe airway hemorrhage, simultaneous suction and laryngoscopy may render intubation difficult. We built a suction laryngoscope that consists of an adjustable stainless steel-guide tube fixed at the lingual surface of a standard Macintosh laryngoscope blade. Via this steel-guide tube, a large suction catheter can be inserted and positioned exactly to suction pharyngeal blood or vomitus, rendering simultaneous suctioning and laryngoscopy possible. In contrast to previous suction laryngoscopes, our suction catheter has a large lumen, which enables fast suctioning and exact placement by adjusting the steel-guide tube. To assess whether our suction laryngoscope could provide better intubation conditions in comparison to a standard Macintosh laryngoscope in a bleeding airway scenario, 44 medical students intubated a manikin with severe simulated airway hemorrhage using our suction laryngoscope and a standard Macintosh laryngoscope in random order. There was no significant difference in time needed for intubation when using the suction versus the Macintosh laryngoscope (mean ± sd: 43 ± 13 vs 52 ± 31 s; P = 0.07), but the number of esophageal intubations was significantly lower when using the suction laryngoscope [6 of 44 (13.6%) vs 19 of 44 (43.2%); P = 0.004]. In conclusion, when compared with a standard Macintosh laryngoscope, using a suction laryngoscope did not result in more rapid intubation, but significantly decreased the likelihood of esophageal intubations.