The literature from LMA about its Supreme laryngeal mask reads, "Use it everywhere you use a mask, and in places you have been using an ET tube." One of those places is now the Phoenix Fire Department (PFD) in Arizona. After using other types of airways, including the ET tube, Phoenix Fire switched to the LMA Supreme as the rescue airway to be used in place of ET tubes about a year ago.
"It was a natural progression," according to PFD Medical Director John Gallagher, MD. "Anesthesiologists in area hospitals are using the LMA Supreme on around half the patients they see, rather than intubation." Gallagher says PFD paramedics are trained by hospital anesthesiologists on the LMA Supreme, so using it in the field just makes sense.
Gallagher says they have experienced problems with other products when used—too long, too stiff, difficult to place. The LMA Supreme is easier to place than competitors' airways and PFD paramedics have a higher success rate for correct placement. PFD has found that the Supreme is a superior product, yet comparably priced to other disposable airways.
ET tubes carry an inherent risk of patient trauma, from vocal cord damage to pharyngeal soft-tissue injury. The LMA Supreme design offers subtle refinements in the mask that make correct placement easier. Several simple and quick tests help verify accurate positioning. Its integrated drain tube is designed to channel fluid and gas safely away from the airway.
Currently use of the LMA Supreme is limited to paramedics, but Gallagher says they are also teaching BLS-level response personnel at PFD how to use it. "If you're going to place an OPA, using the LMA mask will give you a superior airway," he says. Gallagher says at the state level, Arizona is currently looking at whether to add this skill to EMT-B scope of practice.