Cancer cachexia is a complex syndrome characterized not only by a significant weight loss with rapid fall of body mass index (BMI), fatigue, drop of performance clinical indices but also by an important muscle wasting with loss of lean body mass and physical power, and biological abnormalities such as inflammatory syndrome, anemia, reduction of albumin and pre-albumin serum rates [1]. Cachexia, observed in more than 50% of cancer cases, is not easy to manage and, by now, no standard treatment has been acknowledged [1].

BackgroundBystander resuscitation plays an important role in lifesaving cardiopulmonary resuscitation (CPR). A significant reduction in the "no-flow-time", quantitatively better chest compressions and an improved quality of ventilation can be demonstrated during CPR using supraglottic airway devices (SADs). Previous studies have demonstrated the ability of inexperienced persons to operate SADs after brief instruction. The aim of this pilot study was to determine whether an instruction manual consisting of four diagrams enables laypersons to operate a Laryngeal Mask Supreme® (LMAS) in the manikin.MethodsAn instruction manual of four illustrations with speech bubbles displaying the correct use of the LMAS was designed. Laypersons were handed a bag containing a LMAS, a bag mask valve device (BMV), a syringe prefilled with air and the instruction sheet, and were asked to perform and ventilate the manikin as displayed. Time to ventilation was recorded and degree of success evaluated.ResultsA total of 150 laypersons took part. Overall 145 participants (96.7%) inserted the LMAS in the manikin in the right direction. The device was inserted inverted or twisted in 13 (8.7%) attempts. Eight (5.3%) individuals recognized this and corrected the position. Within the first 2 minutes 119 (79.3%) applicants were able to insert the LMAS and provide tidal volumes greater than 150 ml (estimated dead space). Time to insertion and first ventilation was 83.2 ± 29 s. No significant difference related to previous BLS training (P = 0.85), technical education (P = 0.07) or gender could be demonstrated (P = 0.25).ConclusionIn manikin laypersons could insert LMAS in the correct direction after onsite instruction by a simple manual with a high success rate. This indicates some basic procedural understanding and intellectual transfer in principle. Operating errors (n = 91) were frequently not recognized and corrected (n = 77). Improvements in labeling and the quality of instructional photographs may reduce individual error and may optimize understanding.

Background: "Chest compressions only" resuscitation (CCOR) has been suggested one method of increasing laypersons attendance providing bystander resuscitation, avoiding mouth-to-mouth (MTM) ventilation and improving patients' outcome. In prolonged CCOR without rescue breaths and a non-cardiac origin, neurological outcome is very much dependent on oxygenation. As an alternative to MTM we investigated laypersons ability to operate supraglottic airway devices (SAD) in the manikin, following illustrated on-site instruction. Methods: Laypersons were handed a bag containing either an LMAS or an LT, a bag-mask-valve device (BMV), a syringe prefilled with air, and an instruction manual consisting of four annotated diagrams displaying the correct use of either the Laryngeal Mask Supreme™ (LMAS) or the Laryngeal Tube™ (LT). They were then asked to perform and ventilate a manikin as displayed. The process was evaluated in quantity and quality. Results: A total of 299 laypersons were enrolled. 145 applicants in the LMAS (96.7%) and 143 in the LT (96%) group inserted the SAD in the right direction. Previous BLS education was not associated with a higher rate of success (LMAS (P=0.85) vs. LT (P=0.63)). The most common error identified was the depth of insertion (LT 40.9% (n=61) vs. LMAS 32.7% (n=49); P=0.18). No significant difference was found with regard to positioning the devices twisted or reversed (LT 4.7% (n=7) vs. LMAS 6% (n=9); P=0.79). Conclusion: In simulated setting laypersons can achieve appropriate skills and understanding for both SADs using a simple instruction manual. Application of SADs may be improved by a better labeling, the quality of the instruction sheet and a reduction in steps required. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h