LMA Or ET Tube?

For any health care provider, the main concern is always with the patient's airway. Before taking care of any other problem, patency of the airway must be established. Some of the most common and reliable medical devices used to maintain a patent airway is the Endotracheal tube, most commonly referred to as ET tube, and the Laryngeal Mask Airway, or LMA for short. The ET tube is a device used mostly in the pre-hospital setting and in the operating room. The ET tube is a flexible, translucent tube open at both ends and available in lengths ranging from twelve to thirty-two centimeters. The tube is inserted into the trachea through the vocal chords using a laryngoscope and a stylet to maneuver through the airway passage.

The distal end has a beveled tip to facilitate smooth movement. The LMA is an alternative airway device used for anesthesia and airway support. It consists of an inflatable silicone mask and rubber connecting tube. It is inserted blindly into the pharynx, forming a low-pressure seal around the laryngeal inlet and permitting gentle positive pressure ventilation. All parts are latex-free. Both devices are very similar, yet distinctly unique. The ET tube and the LMA, although very different in many ways, are tools that aid in maintaining patent airways in patients, therefore increasing their possibilities for survival.

The similarities between the ET tube and the LMA are very distinct. The ET tube and the LMA are used mostly in Emergency Medicine. Health care providers such as doctors and paramedics use them for airway management. Both devices consist of a tube with an inflatable cuff. When a patient is about to undergo a procedure that involves general anesthesia, either the LMA or the ET tube are used to maintain patency of the airway. Both LMA and ET tubes attach to a ventilator or a Bag-Valve Mask, also known as a BVM, to allow great control over the airway.

The Endotracheal intubation has clearly been the preferred method of advanced airway management in pre-hospital emergency care, because it allows the greatest control of the airway. It was developed by Sir Ivan Whiteside Magill along with plastic surgeon Harold Gilles. The ET tube is directly inserted into the trachea all the way down to the carina of the bronchi. This device is very difficult to insert. It takes a lot of study and practice on mannequins to be able to perform this skill. Even with practice on mannequins, it is still difficult and very different when attempting to intubate a real person. The ET tube is inserted with the used of an ice pick like device called a laryngoscope composed of a blade and a handle. The laryngoscope has a light at the base of a blade to allow a better field of view of the vocal chords. To manipulate the ET tube down the airway, by means of a malleable stylet, which is a plastic covered metal wire. This procedure can also be performed "blind" or with the use of the attendant's fingers; this is called digital intubation. Endotraheal Intubation is used in cardiac arrest, in which ventilation with mask is either impossible or ineffective, respiratory arrest, when the oxygenation with noninvasive methods is inadequate, a patient that is unable to protect airways such as cardiac arrest, coma, or when hospitalized in the Intensive Care Unit, and in general anesthesia. The ET tube is very efficient, but is also painful to insert. General anesthesia and muscle relaxors are required to make the intubation less irritant for the patient. ET tubes protect the airway or lungs from aspiration of regurgitated material. Also, suction of fluids and secretions is possible through the ET tube.

The Laryngeal Mask Airway was invented by British anesthetist, Dr. Archie Brain. It is a very unique device used in airway management. Although the ET Tube and the LMA are used for the same purpose, they differ greatly. The LMA is not inserted as far as the ET tube. It is inserted directly into the pharynx. The device is mostly used when the patient is trapped in a sitting position. It is used when there is suspected trauma to the cervical spine, and if a head-tilt chin lift is not possible. Also, it is used when intubations with an ET tube is unsuccessful. The LMA causes less pain and coughing than ET tubes. Unlike the ET tube, deep subglottic suctioning cannot be performed through the mask. The LMA is much easier to insert than an ET tube. The LMA does not always protect from aspiration. The LMA does not always protect from aspiration. It does not allow for suction of fluids and secretions through the mask.

Even though these two items serve the same purpose, the technique to use them, the functions they serve, and their styles are very different. The ET tube is more reliable and controllable, but the LMA is much more comfortable both for the patient and to insert. The LMA does not prevent aspiration, as the ET tube does. Each item has its benefits and disadvantages. That is why health care providers have a choice when managing the airway. The number one rule is to always do what is in the patient's best interest.