The use of the laryngeal mask airway in CPR

Kokkinis, K.

doi:10.1016/0300-9572(94)90015-9

Cited by 67 publications

(23 citation statements)

References 17 publications

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“…The current investigation has addressed this by using the lateral insertion technique [10], which has a higher reported success rate in children [9,10] than the Brain's technique. Despite making this change, the rate of successful LMA insertion remains similar to that we previously reported, and comparable to success rates reported for adult cardiac arrest [16][17][18].…”

Section: Discussionsupporting

confidence: 69%

A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children

Blevin¹,

McDouall²,

Rechner³

et al. 2009

Anaesthesia

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In adults, first responders to a cardiopulmonary arrest provide better ventilation using a laryngeal mask airway than a facemask. It is unclear if the same is true in children. We investigated this by comparing the ability of 36 paediatric ward nurses to ventilate the lungs of 99 anaesthetised children (a model for cardiopulmonary arrest) using a laryngeal mask airway and using a facemask with an oropharyngeal airway. Anteroposterior chest wall displacement was measured using an ultrasonic detector. Nurses achieved successful ventilation in 74 (75%) of cases with the laryngeal mask airway and 76 (77%) with facemask and oropharyngeal airway (p = 0.89). Median (IQR [range]) time to first breath was longer for the laryngeal mask airway (48 (39-65 [8-149])) s than the facemask ⁄ airway (35 (25-53 [14-120]) s; p < 0.0001). In 10 cases (10%) the lungs were ventilated using the laryngeal mask airway but not using the facemask ⁄ oropharyngeal airway. We conclude that ventilation is achieved rapidly using a facemask and oropharyngeal airway, and that the laryngeal mask airway may represent a useful second line option for first responders. The laryngeal mask airway (LMA) has been advocated as a device for airway management during the resuscitation of adults following cardiopulmonary arrest [1] but its role in the resuscitation of children is less clear. Tracheal intubation, the gold standard for securing the airway, is a difficult skill to acquire and maintain and can lead to further complications if an unsuccessful intubation is not recognised [2,3]. In contrast, insertion of the LMA can be learnt quickly and easily by inexperienced personnel [2, 4-6]; however, the LMA is not currently recommended for first line airway management in children requiring resuscitation [7].In an attempt to establish the utility of the LMA during resuscitation of children by first responders untrained in tracheal intubation, we have previously studied paediatric critical care nurses [8]. Their ability to ventilate the lungs of an apnoeic, anaesthetised child using an LMA was compared with that using a facemask and oropharyngeal airway. We found no difference in the efficacy of ventilation between the two methods; however, ventilation with the LMA took significantly longer to achieve. Two main limitations of that study are first, the practitioners were relatively experienced with facemask ventilation and as such may not be representative of first responders to cardiopulmonary arrests in children. Second, the method of LMA insertion that was taught was the method advocated by Brain in adults and this may not be optimal, studies having shown that the lateral insertion technique has a higher success rate in children [9][10][11].In view of these limitations we have repeated our randomised crossover trial, comparing the LMA with the facemask and oropharyngeal airway for manual ventilation of the lungs of apnoeic anaesthetised children. We studied ward based paediatric nurses as our cohort of practitioners as we felt their skills were more likely to...

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Section: Discussionsupporting

confidence: 69%

A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children

Blevin¹,

McDouall²,

Rechner³

et al. 2009

Anaesthesia

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“…There are published studies in patients undergoing CPR or during trauma management with the cLMA [93][94][95][96], the SLMA [44,97], the ILMA [98][99][100][101][102][103], the i-gel [104], the Combitube [95,96,[105][106][107] and versions of the Laryngeal Tube [108,109]. None of these studies have been adequately powered to enable survival to be studied as a primary endpoint; instead, most researchers have studied insertion and ventilation success rates.…”

Section: Intubation Through a Sadmentioning

confidence: 99%

Supraglottic airways in difficult airway management: successes, failures, use and misuse

Timmermann

2011

Anaesthesia

168

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SummarySupraglottic airway devices (SAD) play an important role in the management of patients with difficult airways. Unlike other alternatives to standard tracheal intubation, e.g. videolaryngoscopy or intubation stylets, they enable ventilation even in patients with difficult facemask ventilation and simultaneous use as a conduit for tracheal intubation. Insertion is usually atraumatic, their use is familiar from elective anaesthesia, and compared with tracheal intubation is easier to learn for users with limited experienced in airway management. Use of SADs during difficult airway management is widely recommended in many guidelines for the operating room and in the pre‐hospital setting. Despite numerous studies comparing different SADs in manikins, there are few randomised controlled trials comparing different SADs in patients with difficult airways. Therefore, most safety data come from extended use rather than high quality evidence and claims of efficacy and particularly safety must be interpreted cautiously.

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“…Although originally designed for elective anaesthesia, it has rapidly gained success in emergency care. Successful insertion rates ranging from 64% to 100% (30,31) have been demonstrated among inexperienced EMS care providers, nurses and respiratory therapists. Training in the placement and use of cLMA seems to be simpler than ETI (32)(33)(34)(35).…”

Section: Lmamentioning

confidence: 99%

Pre‐hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine

Berlac

Hyldmo

Kongstad³

et al. 2008

Acta Anaesthesiol Scand

111

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This article is intended as a generic guide to evidencebased airway management for all categories of pre-hospital personnel. It is based on a review of relevant literature but the majority of the studies have not been performed under realistic, pre-hospital conditions and the recommendations are therefore based on a low level of evidence (D). The advice given depends on the qualifications of the personnel available in a given emergency medical service (EMS). Anaesthetic training and routine in anaesthesia and neuromuscular blockade is necessary for the use of most techniques in the treatment of patients with airway reflexes. For anaesthesiologists, the Task Force commissioned by the Scandinavian Society of Anaesthesia and Intensive Care Medicine recommends endotracheal intubation (ETI) following rapid sequence induction when securing the pre-hospital airway, although repeated unsuccessful intubation attempts should be avoided independent of formal qualifications. Other physicians, as well as paramedics and other EMS personnel, are recommended the lateral trauma recovery position as a basic intervention combined with assisted mask-ventilation in trauma patients. When performing advanced cardiopulmonary resuscitation, we recommend that non-anaesthesiologists primarily use a supraglottic airway device. A supraglottic device such as the laryngeal tube or the intubation laryngeal mask should also be available as a backup device for anaesthesiologists in failed ETI. Accepted for publication 25 February 2008Key words: Pre-hospital; airway management; endotracheal intubation; laryngeal mask airway; laryngeal tube airway; combitube; emergency medical systems. Purpose T HIS article is intended as a guide to evidencebased pre-hospital airway management. The available litterature on pre-hospital airway management reflects vast differences in pre-hospital emergency medicine service (EMS) organisation, qualification levels, training programmes and even terminology. These differences make comparisons between systems and treatment protocols difficult at best. The conduct of clinical trials in pre-hospital airway management is hampered by the 2001/20/ EC directive of the European Parliament concerning informed consent. This paper describes selected equipment and techniques available for pre-hospital airway management. Advice given differs, depending on which category of personnel is available in a given EMS. Our baseline assumption is that a certain level of education and training is necessary for the safe use of a specific technique. Distinction must be made between personnel trained and experienced in providing and monitoring anaesthesia and other groups of personnel with limited or no anaesthetic skills. This distinction dictates which drugs and equipment that should be available in the prehospital setting. Differences between regions and systemsParamedic-based systems are the rule in the United States, whereas physician-based pre-hospital systems are common in Europe. Ideally, the best person to manage the pre-hospital airwa...

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The use of the laryngeal mask airway in CPR

Cited by 67 publications

References 17 publications

A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children

A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children

Supraglottic airways in difficult airway management: successes, failures, use and misuse

Pre‐hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine

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