Randomised comparison of the SLIPA™, (Streamlined Liner of the Pharynx Airway), and the SS-LM (Soft Seal Laryngeal Mask) by health professional trainees

Background and Goal of the Study: The need to establish a patent airway is a vitally important skill for paramedics where experience and patient exposure may limit success. The Laryngeal Mask Airway has been well established as a device that can be used even by those who are novices [1-3]. The SLIPA™ is a new supraglottic airway device that has previously been shown to be easy to insert by medical officers and anaesthetists of varying experience [4]. Additionally, the SLIPA™ requires less steps for placement as it does not require cuff inflation and has a "bite-block" within its shaft. These features suggest that the SLIPA™ may be a useful airway device for inexperienced users. This randomised crossover trial compared the SLIPA™ (Hudson) and the SS-LM (Portex) in terms of success rates, time taken for insertion and user preference, when inserted by novice users. Methods: Ethics committee approvals were obtained and the Therapeutic Goods Administration was informed of a multi-centre trial. Thirty-six medical students who had not used or been trained to use either device were trained in the airway laboratory and assessed by OSCE (Objective Structured Clinical Exam). The students then inserted each device, in randomised sequence, in two separate patients with only 2 insertion attempts per patient allowed. Patients were excluded if they were under the age of 18 years, had not given informed consent, had illnesses associated with delayed gastric emptying, morbid obesity, risk of pulmonary aspiration or were pregnant. Outcome measures were; success or failure; success at first attempt and time to ventilation. The primary outcome was, which device did the students prefer to use. Results: The SLIPA™ was successfully inserted (1 or 2 attempts) in 94% of patients (34/36) and the SS-LM in 89% (32/36). 1st attempt success rates were 83% (30/36) and 67% (24/36) in the SLIPA™ and SS-LM respectively. Median time to ventilation (removal of facemask to chest inflation) was 41.6 seconds (22.1 - 236) with the SLIPA™ and 55 seconds with the SS-LM (31.1- 233.3) (p .014). Sixty-seven percent of the students preferred to use the SLIPA™. Conclusions: In this study, students demonstrated high success rates with both devices even though they were novice users. The shorter times to ventilation in the SLIPA™ group may prove to be of clinical significance, particularly in the emergency setting. Whilst the Laryngeal Mask has gained wide recognition for use by both novice users and as a rescue airway in failed intubation, the data presented here suggests that the SLIPA™ may also prove useful in these areas. The challenge now, would be to access its potential use within the pre-hospital environment.