Written by Aaron Lacy
The traditional process of using an intubating LMA (ILMA) leaves the patient without ventilation for a significant amount of time and can lead to tube dislodgement – both not good. This new technique, using readily available equipment, addresses both problems.
Why does this matter?
The ILMA is a useful tool if used correctly and practiced. These authors suggest a change that could help the tool become more practical for use in patients undergoing intubation who are critically ill.
Double trouble or double the fun?
If you are not familiar with the Fastrach LMA (the ILMA in this study) check out this video from OpenAirway reviewing the device and its use.
Removal of the ILMA requires a proprietary stylet that predisposes the patient to accidental extubation, and during the ILMA removal process, it is also not possible to ventilate the patient – both bad scenarios. The proposed two-person solution is as follows.
Step 1: The set-up
The authors term this the “double-endotracheal tube setup.” Be careful not to lose the 7.0 tube adapter, as you need it later!
Step 2: The intubation
After your ILMA is placed and you have confirmed ventilation and oxygenation with the device, the double-endotracheal tube setup is fed through the ILMA to intubate the trachea.
Step 3: ILMA Removal
Here is the key difference from the standard ILMA procedure. The proceduralist holds the double tube setup as one unit, allowing it to act as a removal stylet that is (supposedly) less likely to become displaced and allows an assistant to deliver continual oxygen and ventilation.
Step 4: Disconnect and replace
At this point the 6.0 tube is removed from the 7.0 tube, and the 7.0 adapter is replaced. This is the only brief pause in ventilation and oxygenation. Confirm tube placement with standard means.
The authors’ impression
Like all procedures, practice makes both perfect and permanence. This is a novel idea on how to potentially optimize and prevent pitfalls using the ILMA, but it is off label. If you are going to do this, try it out on a manikin first and ensure all team-members are on the same page when it comes time for the procedure.
There is a video demonstration linked at the end of the article when accessed through the publisher site (below).
The Hennepin Double-Tube Technique: A More Efficient Method of Tracheal Intubation Through the LMA Fastrach. J Emerg Med. 2022 Aug 4. DOI: 10.1016/j.jemermed.2022.04.003