Insertion of four different types of supraglottic airway devices by emergency nurses. A mannequin-based simulation study. : Insertion of SADs by emergency nurses

Insertion of four different types of supraglottic airway devices by emergency nurses. A mannequin-based simulation study.

Insertion of SADs by emergency nurses



Airway management; Supraglottic airway devices; Manikin study; Nurse education; Nurses.


Background: During medical emergencies, one of the main steps to improve patient outcomes is to achieve airway management. Orotracheal intubation is highly effective for advanced airway management, but it requires experienced health professionals. The use of a supraglottic airway device (SAD) is an acceptable alternative. Aim: To assess which of the four considered SADs takes the shortest time and the lowest number of attempts to be correctly placed. The secondary aim was to evaluate the influence of some characteristics of the study population on time taken and number of attempts required. Methods: A crossover trial was conducted at the Advanced Medical Simulation Center of the University of Perugia (Italy) between June and September 2017. Eighty-three nurses were enrolled in the study. Each participant was asked to place four different SADs in a manikin: Laryngeal Tube Suction-D (LTS-D), i-gel™, Ambu® Laryngeal Mask AuraGain™ and LMA® Protector™ Cuff Pilot™. Results: The median insertion time for the different devices was: 8.0 seconds (s) for LTS-D, 6.0 s for i-gel, 5.4 s for AuraGain, 5.8 s for LMA Protector (p<0.05); the median number of insertion attempts was: 2 for LTS-D, 1 for i-gel, AuraGain and LMA Protector (p<0.05). There was no significant relationship between insertion time and attempts required and the participants’ working experience, training, or knowledge of the devices. Conclusion: With the exception of LTS-D, which had the worst performance, there was a high degree of homogeneity between the studied SADs in terms of time and attempts required to achieve correct placement.

Author Biographies

Alessandro Liti, University of Perugia


Gian Domenico Giusti, Azienda Ospedaliero Universitaria di Perugia. Didactic Tutor. School of Nursing Department of Experimental Medicine University of Perugia


Mirella Giontella, Azienda Ospedaliero Universitaria di Perugia. School of Nursing Department of Medicine University of Perugia

Head Nurse

Sara Dell'Omo, University of Perugia


Vincenzo Camerlingo, U.O. Ortopedia-Urologia, Azienda USL Umbria2.


Alessandra Fronteddu, AUSL della Romagna. Ospedale “Santa Maria delle Croci”, Medicina d’Urgenza.


Alessandro Galazzi, Department of Anesthesia, Intensive Care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy


Stefano Bambi, Medical and Surgical Intensive Care Unit. Azienda Ospedaliero Universitaria Careggi, Florence



White L, Melhuish T, Holyoak R, Ryan T, Kempton H, Vlok R. Advanced airway management in out of hospital cardiac arrest: A systematic review and meta-analysis. Am J Emerg Med. 2018;36(12):2298‐2306. doi:10.1016/j.ajem.2018.09.045

Soar J, Nolan JP. Airway management in cardiopulmonary resuscitation. Curr Opin Crit Care. 2013;19(3):181‐187. doi:10.1097/MCC.0b013e328360ac5e

Soar J, Nolan JP, Böttiger BW, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation. 2015;95:100‐147. doi:10.1016/j.resuscitation.2015.07.016

Callaway CW, Soar J, Aibiki M, Böttiger BW, Brooks SC, Deakin CD, et al. Part 4: Advanced Life Support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2015;132(16 Suppl 1):S84‐S145. doi:10.1161/CIR.0000000000000273

Fouche PF, Simpson PM, Bendall J, Thomas RE, Cone DC, Doi SA. Airways in out-of-hospital cardiac arrest: systematic review and meta-analysis. Prehosp Emerg Care. 2014;18(2):244‐256. doi:10.3109/10903127.2013.831509

Lucchini A, Bambi S, Galazzi A, Elli S, Negrini C,et al. Unplanned extubations in general intensive care unit: A nine-year retrospective analysis. Acta Biomed. 2018;89(7-S):25‐31. Published 2018 Dec 7. doi:10.23750/abm.v89i7-S.7815

Wang HE, Yealy DM. How many attempts are required to accomplish out-of-hospital endotracheal intubation?. Acad Emerg Med. 2006;13(4):372‐377. doi:10.1197/j.aem.2005.11.001

Wang HE, Schmicker RH, Daya MR, et al. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2018;320(8):769‐778. doi:10.1001/jama.2018.7044

Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251‐270. doi:10.1097/ALN.0b013e31827773b2

Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115(6):827‐848. doi:10.1093/bja/aev371

Brain AI. The development of the Laryngeal Mask--a brief history of the invention, early clinical studies and experimental work from which the Laryngeal Mask evolved. Eur J Anaesthesiol Suppl. 1991;4:5‐17.

Brimacombe J. A proposed classification system for extraglottic airway devices. Anesthesiology. 2004;101(2):559. doi:10.1097/00000542-200408000-00054

Ramachandran SK, Kumar AM. Supraglottic airway devices. Respir Care. 2014;59(6):920‐932. doi:10.4187/respcare.02976

An J, Nam SB, Lee JS, et al. Comparison of the i-gel and other supraglottic airways in adult manikin studies: Systematic review and meta-analysis. Medicine (Baltimore). 2017;96(1):e5801. doi:10.1097/MD.0000000000005801

Jackson KM, Cook TM. Evaluation of four airway training manikins as patient simulators for the insertion of eight types of supraglottic airway devices. Anaesthesia. 2007;62(4):388‐393. doi:10.1111/j.1365-2044.2007.04983.x

Castle N, Pillay Y, Spencer N. Insertion of six different supraglottic airway devices whilst wearing chemical, biological, radiation, nuclear-personal protective equipment: a manikin study. Anaesthesia. 2011;66(11):983‐988. doi:10.1111/j.1365-2044.2011.06816.x

Lee DW, Kang MJ, Kim YH, et al. Performance of intubation with 4 different airway devices by unskilled rescuers: manikin study. Am J Emerg Med. 2015;33(5):691‐696. doi:10.1016/j.ajem.2015.03.006

Gruber E, Oberhammer R, Balkenhol K, et al. Basic life support trained nurses ventilate more efficiently with laryngeal mask supreme than with facemask or laryngeal tube suction-disposable--a prospective, randomized clinical trial. Resuscitation. 2014;85(4):499‐502. doi:10.1016/j.resuscitation.2014.01.004

Ruetzler K, Gruber C, Nabecker S, et al. Hands-off time during insertion of six airway devices during cardiopulmonary resuscitation: a randomised manikin trial. Resuscitation. 2011;82(8):1060‐1063. doi:10.1016/j.resuscitation.2011.03.027

Henlin T, Sotak M, Kovaricek P, Tyll T, Balcarek L, Michalek P. Comparison of five 2nd-generation supraglottic airway devices for airway management performed by novice military operators. Biomed Res Int. 2015;2015:201898. doi:10.1155/2015/201898

Chen PT, Huang YC, Cheng HW, et al. New simulation-based airway management training program for junior physicians: Advanced Airway Life Support. Med Teach. 2009;31(8):e338‐e344. doi:10.1080/01421590802641471




How to Cite

Liti A, Giusti GD, Gili A, Giontella M, Dell'Omo S, Camerlingo V, et al. Insertion of four different types of supraglottic airway devices by emergency nurses. A mannequin-based simulation study. : Insertion of SADs by emergency nurses. Acta Biomed [Internet]. 2020 Nov. 30 [cited 2024 Jul. 14];91(12-S):e2020016. Available from: