Correspondence Attitudes of firefighters towards the use of supraglottic airways devices To the Editor, In the article “Advanced airway management in out of hospital car- diac arrest: A systematic review and meta-analysis” by White et al. pub- lished in The American Journal of Emergency Medicine, the authors indicate that the overall heterogeneous benefit in survival with ETT was not replicated in the low risk randomized controlled trials, with no significant difference in survival or neurological outcome [1]. It is worth noting that endotracheal intubation is a highly specialized proce- dure, requiring from the person performing it a lot of knowledge and skills in its use. As Buis et al. indicate, the learning curve for direct laryn- goscopy is about 50 intubations [2]. In the case of videolaryngoscopy it is much lower [3-5]. After all, because of the cost of videolaryngoscopes, they are relatively rarely used in pre-hospital settings. An alternative to them can be supraglottic airway devices, which in present times are used not only in pre-hospital settings [6,7], but also under operating theatre conditions [8]. The aim of the study was to assess the attitudes of firefighters to- wards the use of supraglottic airway devices. The survey involved 78 firefighters working in the State Fire Service in Poland and participating in rescue operations as part of their profes- sional work. All study participants took part in training in airway man- agement. After the theoretical training, they had the opportunity to practice the practical application of various supraglottic airway devices in the conditions of simulated airway management. For this purpose an adult airway management simulator was used (Sakamoto Airway Man- agement Trainer; SAKAMOTO MODEL CORPORATION; Osaka, Japan). The participants used the following devices: (1) standard Laryngeal Mask Airway (Skamex, Lodz, Poland); (2) iGEL mask (Intersugical Ltd., Berkshire, UK); Ambu® AuraGain™ Disposable Laryngeal Mask (Ambu A/S, Kopenhagen, Denmark); (4) Intubating Laryngeal Tube iLTS-D (iLTS-D; VBM Medizintechnik GmbH, Sulz, Germany); (5) EasyTube (Rüsch, Kenen, Germany). After the theoretical training, they completed a questionnaire, in which they assessed the preferences and ease of performing airway management in the case of various supraglottic airway devices. The ease of airway management was assessed on a 100-degree scale, where ‘1’ meant a very easy procedure and ‘100’ a very difficult procedure. The average age of study participants was 33.5 ± 5.6 years. The study participants did not have medical education. During the training, all participants performed airway management using each method. The most preferred supraglottic airway devices indicated by the participants were iGEL, then iLTS-D, and the least preferred were the standard LMA. The ease with which airway management could be carried out using dif- ferent supraglottic airway devices varied and was adequate: 10 ± 8 points for iGEL, 17 ± 8 points for iLTS-D, 23 ± 10 points for EasyTube, 46 ± 13 points for AMBU, and 52 ± 23 points for standard LMA. As the above study indicates, there are differences in the use of dif- ferent supraglottic airway devices. The iGEL laryngeal mask is the most preferred type of supraglottic airway devices among the fire- fighters surveyed. The training of rescuers in the use of SADs can be a key element of rescue operations, even more so that these devices in comparison with endotracheal intubation do not require from the res- cuer high practical skills. Source of support No sources of financial and material support to be declared. Kurt Ruetzler Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA Department of Outcome Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA Agnieszka Madziala Marcin Madziala Michal Pruc Dominika Dunder* Lazarski University, Warsaw, Poland E-mail address: dominikadunder.sjc@gmail.com (D. Dunder). 13 January 2019 Available online xxxx https://doi.org/10.1016/j.ajem.2019.01.028 References [1] White L, Melhuish T, Holyoak R, et al. Advanced airway management in out of hospi- tal cardiac arrest: a systematic review and meta-analysis. Am J Emerg Med 2018;36 (12):2298–306. https://doi.org/10.1016/j.ajem.2018.09.045. [2] Buis ML, Maissan IM, Hoeks SE, et al. Defining the learning curve for endotracheal in- tubation using direct laryngoscopy: a systematic review. Resuscitation 2016;99: 63–71. https://doi.org/10.1016/j.resuscitation.2015.11.005. [3] Gawel W, Kaminska H, Wieczorek W. UESope as a method of endotracheal intubation of trauma patient. Disaster Emerg Med J 2017;2(4):175–6. https://doi.org/10.5603/ DEMJ.2017.0040. [4] Ladny JR, Sierzantowicz R, Kedziora J, et al. Comparison of direct and optical laryngos- copy during simulated cardiopulmonary resuscitation. Am J Emerg Med 2017;35(3): 518–9. https://doi.org/10.1016/j.ajem.2016.12.026. [5] Madziala M. The ETView tracheoscopic ventilation tube for trauma patient intubation. Disaster Emerg Med J 2018;3(2):69–70. https://doi.org/10.5603/DEMJ.2018.0016. [6] Frass M, Robak O, Smereka J, et al. Securing the airway patency by firefighters with the use of CombiTube. A pilot data. Disaster Emerg Med J 2018;3(2):46–50. https:// doi.org/10.5603/DEMJ.2018.0011. [7] Ladny JR, Bielski K, Szarpak L, et al. Are nurses able to perform blind intubation? Ran- domized comparison of I-gel and laryngeal mask airway. Am J Emerg Med 2017;35 (5):786–7. https://doi.org/10.1016/j.ajem.2016.11.046. [8] Robak O, Vaida S, Somri M, et al. Inter-center comparison of EasyTube and endotra- cheal tube during general anesthesia in minor elective surgery. PLoS One Jun 2 2017;12(6):e0178756. https://doi.org/10.1371/journal.pone.0178756. American Journal of Emergency Medicine xxx (xxxx) xxx YAJEM-58034; No of Pages 1 https://doi.org/10.1016/j.ajem.2019.01.028 0735-6757/© 2019 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem Please cite this article as: K. Ruetzler, A. Madziala, M. Madziala, et al., , American Journal of Emergency Medicine, https://doi.org/10.1016/j. ajem.2019.01.028