Effectiveness of using suction assisted laryngoscopy airway decontamination technique to assist endotracheal intubation with En.An‐II P Video Laryngoscopy® by paramedics in a manikin simulating massive hematemesis: A randomized, crossover, manikin study

Abstract Background Endotracheal intubation (ETI) during massive hematemesis is challenging due to airway contamination. The suction‐assisted laryngoscopy and airway decontamination (SALAD) technique has shown promising results in manikin studies involving emergency doctors, but its effectiveness and feasibility with Hong Kong paramedics, for whom ETI is not a standard practice, remains unexplored. Objectives This study aimed to compare the efficacy of a simplified SALAD technique using a DuCanto catheter versus a conventional technique with a Yankauer suction catheter during paramedic‐performed ETI in a simulated massive hematemesis scenario, while assessing its feasibility for Hong Kong's prehospital system. Methods A randomized crossover manikin study was conducted involving 34 paramedics from the Fire Services Department, Hong Kong Special Administrative Region. Participants performed intubations using both techniques on a high‐fidelity manikin simulating massive hematemesis. Primary outcome was the first attempt intubation success rate. Secondary outcomes included intubation time, aspiration volume, esophageal intubation rate, and participants' perceptions via 5‐point Likert scales. Results SALAD‐1 demonstrated superior performance across multiple metrics including first attempt intubation success rate (73.5% vs. 52.9% and p = 0.078), intubation time (50.56 vs. 58.73 s and p = 0.033), and aspiration volume (22.06 vs. 286.32 mL and p < 0.001). Esophageal intubation occurred in three cases with the conventional method but in none with SALAD‐1, a difference that was not statistically significant ( p = 0.119). Participant feedback strongly favored SALAD‐1 across all evaluation domains (mean scores 4.5–4.79/5 vs. 2.91–3.44/5 and p < 0.001). Conclusions This study provides preliminary evidence that the SALAD technique can be rapidly acquired and effectively applied by Hong Kong paramedics in a simulated setting, demonstrating both clinical advantages and strong operator acceptance. These findings support the integration of SALAD into future paramedic training curricula and warrant further clinical research.