Comparison of Airway Management Using a Laryngeal Mask Airway versus an Endotracheal Tube during Respiratory Emergencies and Their Outcomes
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Abstract
Background: Rapid establishment of a patent airway is fundamental during respiratory emergencies. Endotracheal intubation provides a definitive tracheal airway, whereas the laryngeal mask airway (LMA) offers a supraglottic alternative that may be easier to deploy but provides different airway protection and complication characteristics. Objective: To compare use patterns and complications associated with LMA and endotracheal tube (ETT) placement during respiratory emergencies and to describe procedural and patient outcomes. Methods: This prospective observational comparative study included 150 adults requiring emergency airway management at Maqsood Medical Complex Hospital, Peshawar, over six months. LMA was used in 76 cases and ETT in 74. Patient, operator, procedural, complication, replacement, survival, and provider-satisfaction data were recorded prospectively. Results: LMA and ETT were used in 50.7% and 49.3% of cases, respectively. Any recorded airway complication occurred in 33/76 LMA cases (43.4%) and 14/74 ETT cases (18.9%), corresponding to an unadjusted risk ratio of 2.30 (95% CI 1.34–3.93; Fisher exact p=0.0015). Hypoxia occurred in 21 LMA versus three ETT cases, while aspiration occurred in 10 LMA and no ETT cases. Airway trauma and dislodgement were each recorded in one LMA and five ETT cases. Overall adequate oxygenation and effective ventilation were each recorded in 109/150 cases (72.7%). Device replacement was required in 39/150 (26.0%), and 146/150 patients (97.3%) survived to discharge. Conclusion: LMA and ETT were both used frequently in this emergency cohort, but their recorded complication profiles differed substantially. LMA use was associated with a higher crude overall complication frequency; however, nonrandom device selection, lack of baseline clinical comparability, and possible confounding by indication prevent causal attribution to device type alone.
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