[Supraglottic airway devices in emergency medicine : impact of gastric drainage].

This case report describes a life-saving use of a supraglottic airway device (LT-D™-Larynxtubus, VBM Medizintechnik, Sulz, Germany) in an out-of-hospital emergency patient suffering from severe traumatic brain injury. Mechanical ventilation with the laryngeal tube was complicated by repeated airway obstructions and pronounced gastric distension with air as a consequence of oropharyngeal leakage. In this situation pulmonary ventilation of the patient was compromised so that emergency endotracheal intubation became necessary in the resuscitation area with vital indications. In this context the status of supraglottic airway devices in emergency medicine is discussed as well as the reasons for the gastric distension. Besides the immediate drastic consequences of gastric distension with respect to pulmonary ventilation, potential deleterious non-pulmonary consequences of this complication are highlighted. The clinical relevance of the described complications as well as the associated possibility of an optimized position control necessitate the recommendation only to use second generation supraglottic airway devices with integrated gastric access in (out-of-hospital) emergency medicine.