Clinics (Sao Paulo). 2017 July; 72(7): 422-425.

Copyright © 2017 CLINICS

Laryngeal tube suction for airway management during in-hospital emergencies

Haitham Mutlak I * , Christian Friedrich Weber I , Dirk Meininger I III , Colleen Cuca I , Kai Zacharowski I , Christian Byhahn II , Richard Schalk I

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe-University Hospital, Theodor-Stern Kai 7-10, 60590 Frankfurt, Germany

Department of Anesthesiology and Intensive Care Medicine, Medical Campus, University of Oldenburg, Evangelisches Krankenhaus, Steinweg 13-17, 26122 Oldenburg, Germany

Department of Anesthesiology, Main-Kinzig-Kliniken, Herzbachweg 14, 63571 Gelnhausen, Germany

*Corresponding author. E-mail:

received March 7, 2017; revised April 4, 2017; accepted May 15, 2017.



The role of supraglottic airway devices in emergency airway management is highlighted in international airway management guidelines. We evaluated the application of the new generation laryngeal tube suction (LTS-II/LTS-D) in the management of in-hospital unexpected difficult airway and cardiopulmonary resuscitation.


During a seven-year period, patients treated with a laryngeal tube who received routine anesthesia and had an unexpected difficult airway (Cormack Lehane Grade 3-4), who underwent cardiopulmonary resuscitation, or who underwent cardiopulmonary resuscitation outside the operating room and had a difficult airway were evaluated. Successful placement of the LTS II/LTS-D, sufficient ventilation, time to placement, number of placement attempts, stomach content, peripheral oxygen saturation/end-tidal carbon dioxide development (SpO2/etCO2) over 5 minutes, subjective overall assessment and complications were recorded.


In total, 106 adult patients were treated using an LTS-II/LTS-D. The main indication for placement was a difficult airway (75%, n=80), followed by cardiopulmonary resuscitation (25%, n=26) or an overlap between both (18%, n=19). In 94% of patients (n=100), users placed the laryngeal tube during the first attempt. In 93% of patients (n=98), the tube was placed within 30 seconds. A significant increase in SpO2 from 97% (0-100) to 99% (5-100) was observed in the whole population and in cardiopulmonary resuscitation patients. The average initial etCO2 of 39.5 mmHg (0-100 mmHg) decreased significantly to an average of 38.4 mmHg (10-62 mmHg) after 5 minutes. A comparison of cardiopulmonary resuscitation patients with non-cardiopulmonary resuscitation patients regarding gastric contents showed no significant difference.


LTS-D/LTS-II use for in-hospital unexpected difficult airway management provides a secure method for primary airway management until other options such as video laryngoscopy or fiber optic intubation become available.

Keywords: Difficult Airway Management, Laryngeal Tube, Supraglottic Airway Devices, In-Hospital Emergencies

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