BACKGROUND: Extraglottic devices, such as the intubating laryngeal mask airway (ILMA), facilitate ventilation and oxygenation and are useful for emergency airway management, especially as rescue devices. In the operating room setting the ILMA has been highly successful. However, its performance in the ED has not been described. We sought to describe the indications for and success of the ILMA when used in the ED. METHODS: We performed retrospective, observational study of patients who had an LMA® Fastrach™ (hereafter termed ILMA) placed in a single ED between 2007 and 2017. Patients were identified by keyword search of ED notes in the electronic medical record. Trained abstractors reviewed charts and videos to determine patient characteristics, indication for ILMA placement, success of oxygenation and ventilation, intubation methods and success, and complications related to the device. RESULTS: During the study period 218 patients had an ILMA placed in the ED. The ILMA was used as a primary device in 118 patients (54%), and as a rescue device in 100 patients (46%). The median number of ILMA uses per faculty physician during the study period was 3. The ILMA oxygenated and ventilated successfully in 212 instances (98%), including 96 times (96%) when used as a rescue airway. Failure of oxygenation was due to tracheal injury (2), abnormal laryngeal inlet anatomy (2), or poor operator technique (1). Intubation through the ILMA was successful in 159 of 192 patients (83%), including a success rate of 81% (112 of 139 patients) with blind intubation. CONCLUSION: The ILMA was highly successful in oxygenation, with reasonable intubation success, even when used infrequently by emergency physicians. The ILMA should be considered a valuable primary and rescue intubation device in the ED.