Should there be a change in the teaching of airway management in the medical school curriculum?

Objective: To evaluate the use of the Laryngeal Mask Airway (LMA), the oesophageal-tracheal combitube (ETC) and the tracheal tube (TT) by medical students, with a view to recommend changes to the medical school curriculum.

Methods: A prospective cohort study of 93 third-year medical students were taught the use of LMA, ETC and TT on manikins and had their skills tested at 0 and 6 months.

Results: Overall, LMA insertion was the fastest technique with a mean time taken for successful insertion of 32.2 s, compared to that for ETC (55.0 s, P = 0.000) and TT (71.5s, P = 0.000). There was a significant delay in the time taken for insertion at 6 months for all three devices: 13.5 s for the LMA (P = 0.000), 29.6 s for the ETC (P = 0.000) and 31.8 s for the TT (P = 0.001). Both the ETC and the TT had a significantly lower first-attempt success rate at 6 months (ETC: 91% versus 63%, P = 0.000 and TT: 80% versus 55%, P = 0.003) but not the LMA (96% versus 92%, P = 0.549). At 6 months, the overall success rate was 99% for the LMA, 100% for the ETC and 93% for the TT. Complication rate was higher for the ETC (9% versus 46%, P = 0.000) and the TT (38% versus 78%, P = 0.005) but not for the LMA (3% versus 10%, P = 0.688).

Conclusions: The use of the TT is difficult and the skills acquired by the medical students deteriorate significantly over time. The LMA and the ETC seem to have an advantage over the TT in that they are more easily learnt and the skills better retained. It is recommended that these alternative devices be included in the medical school curriculum for airway management.