Performance Evaluation of Manual vs Battery-Operated Airway Suction Devices

Portable suction devices (PSDs) are essential tools for airway visualization during prehospital airway management, yet the effectiveness of manual versus battery-powered PSDs remains unclear. We evaluated time to airway clearance and operator-rated performance using manual and battery-powered PSDs in a simulation setting.

Using a Suction Assisted Laryngoscopy and Airway Decontamination manikin, we modeled airway regurgitant contamination and clearance with two manual and five battery-powered PSDs. We introduced a standardized volume of simulated regurgitant (thin water-based or thick cracker-gelatin mixtures) into the airway. Operators (paramedics, prehospital nurse educators, and EMS physicians) were timed during airway clearance with each PSD and verbally indicated when vocal cords were visible. They also rated PSD performance across five domains (ease of use, adequate suction, visualization of the airway, overall ease of airway clearance, and perceived suitability for field use) using 5-point Likert scales. We fit a log-transformed linear mixed-effects model with random intercepts for operator and specific PSD to evaluate the association between PSD type (manual vs battery-powered) and time to airway visualization (primary outcome). We used t-tests to assess differences in the mean 25-point composite scores.

Operators completed 109 attempts: 50 (46%) by nurses, 29 (27%) by EMS physicians, 26 (24%) by paramedics, and 4 (4%) by other/unknown. Median time to airway clearance was 6.1 seconds (IQR 4.6-8.2). Operators achieved faster airway visualization with battery-powered compared to manual PSDs (5.7 seconds [95% CI 4.9-6.6] vs 8.2 seconds [95% CI 6.8-9.9]). In adjusted modeling, use of manual PSDs increased time to airway visualization by 44%. Mean composite scores for PSD performance were 22.9 (95% CI 22.2-23.5) for battery-powered and 18.6 (95% CI 17.3-19.9) for manual (difference 4.3, 95% CI 2.8-5.7).

In this simulation study, EMS providers achieved faster airway visualization and had higher satisfaction with portable battery-powered PSDs compared to manual. Although limited by the simulated environment, these findings support the preferential use of battery-powered PSDs during field airway management despite their additional cost and weight.