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Background: The administration of sedation and neuromuscular blockade to facilitate extraglottic device (EGD) placement is known as rapid sequence airway (RSA). In the emergency department (ED), EGDs are used largely as rescue devices. In select patients, there may be significant advantages to using EGDs over laryngoscopy as the primary airway device in the ED., Objective: Our study sought to describe the practice of RSA in the ED, including rates of successful oxygenation, ventilation, and complications from EGD use., Methods: We identified patients in the ED between 2007 and 2017 who underwent RSA with the LMA® Fastrach™ (hereafter termed ILMA; Teleflex Medical Europe Ltd., Athlone, Ireland) placed as the first definitive airway management device. A trained abstractor performed chart and video review of the cases to determine patient characteristics, physician use of the ILMA, indication for ILMA placement, success of oxygenation and ventilation, success of intubation, and complications related to the device., Results: During the study period, 94 patients underwent RSA with the ILMA. Of those, 93 (99%) were successfully oxygenated and ventilated, and when intubation was attempted, 89% were able to be intubated through the ILMA. The incidence of vomiting and aspiration was 1% and 3%, respectively. There were 30 different attending physicians who supervised RSA and the median number was 2 per physician in the 10-year study period., Conclusion: The practice of RSA with the ILMA in the ED is associated with a high rate of successful oxygenation, ventilation, and intubation with infrequent complications, even when performed by physicians with few experiences in the approach., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: The intubating laryngeal mask airway (ILMA) allows providers to blindly intubate through the device. We report a case of foreign material obstructing passage of an endotracheal tube (ET) through an ILMA., Case Report: A 45-year-old man with unknown past medical history was found obtunded with an apparent intentional drug and alcohol overdose, and required tracheal intubation. We opted to use an ILMA to optimize preoxygenation prior to intubation. His upper dentures were removed and an ILMA was inserted without complication; ventilation was easily performed. Blind tracheal intubation was attempted; the ET was inserted through the ILMA and was unable to be advanced past 15 cm despite multiple attempts, including repositioning the ILMA and rotating the ET. The ILMA was removed to prepare for video laryngoscopy. He was subsequently successfully intubated using a standard geometry video laryngoscope, which showed no anatomical abnormalities. After the case, the ILMA was inspected and the bowl of the ILMA was found to be occluded with denture adhesive. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report demonstrates that it is possible that foreign material within the ILMA can make successful intubation impossible, despite successful placement and ventilation through the device. Maneuvers may be performed to attempt successful ET intubation, but when unsuccessful, removal of the ILMA and alternate airway management must be performed., (Copyright © 2019 Elsevier Inc. All rights reserved.)