Use of an intubating laryngeal mask airway on out-of-hospital cardiac arrest patients in a developing emergency medical service system

Chien, Li Chien; Hsu, Hui‐Ping; Lin, Chih Hao; Cheng, Ching Fa; Tung, Yung Chuang; Hung, Hsien Cheng; Yeh, Yu Ching; Tsai, Ming-Chao

doi:10.1016/j.jfma.2012.01.004

Cited by 11 publications

(8 citation statements)

References 27 publications

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“…Although the authors declare no significant difference in demographic data, the BVM group had a higher incidence of traumatic arrest (21.3% vs. 14.2%), and two key chronic co-morbidities (cerebrovascular 13.5% vs. 4.2%, and diabetes 28.1% vs. 16.9%) (27). The feasibility study from Austria (26) was similar to the feasibility Taiwanese study (27), looking at introducing the LT to their EMS system (26). The methods of this study indicate that the LT would be the primary airway device used in an OHCA, without any prior BVM ventilation, and also if the LT had two failed insertion attempts then BVM would be used instead.…”

Section: Comparison Of Sad and Bvm Studiesmentioning

confidence: 89%

“…The results for the patient outcomes section are conflicting, and report associations that are not congruent with the wellknown airway management gold standard of ETI, with two large studies reporting more favourable patient outcomes for BVM in comparison to ETI (1,2). In comparison between SADs and BVM, three studies report that BVM ventilation was associated with greater patient outcomes (1,2,5), one study reported favourable patient outcomes were similar between advanced airway and BVM ventilation (28), and two studies reported higher successful ventilation and 24 hour survival rates of SADs over BVM (26,27). The majority of patient outcome focussed studies with large sample sizes originate from Japan or the USA, and to a lesser extent, Korea.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence rate of ROSC and 24-hour survival (Table 6) for the BVM and I-LMA groups were extremely high, with the latter group also showing an improvement. Although the authors declare no significant difference in demographic data, the BVM group had a higher incidence of traumatic arrest (21.3% vs. 14.2%), and two key chronic co-morbidities (cerebrovascular 13.5% vs. 4.2%, and diabetes 28.1% vs. 16.9%) (27). The feasibility study from Austria (26) was similar to the feasibility Taiwanese study (27), looking at introducing the LT to their EMS system (26).…”

Section: Comparison Of Sad and Bvm Studiesmentioning

confidence: 97%

“…Successful ventilation was self-reported by the attending operators (EMTs who placed the device and an emergency physician that managed the patient afterward) and varied widely between the groups (26). Both studies have the potential of self-reporting bias, and both are restricted by limited training and relatively inexperienced operators (26,27).…”

Section: Comparison Of Sad and Bvm Studiesmentioning

confidence: 99%

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Use of Supraglottic Airway Devices by Paramedics in the Management of Adult Prehospital Cardiac Arrest Patients

Barr

Smith

Darroch

2017

Australasian Journal of Paramedicine

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IntroductionCurrent best practice for paramedic airway management of prehospital cardiac arrest is being continually reviewed following changes to the emphasis on intubation as a primary intervention within international resuscitation guidelines. Subsequently, there is increased enthusiasm for the use of next generation supraglottic airway devices. This review aimed to identify the current evidence for the safety and effectiveness of supraglottic airways for the management of prehospital cardiac arrest. MethodsA search of the electronic databases Medline, PubMed, Science Direct and Cochrane Library was conducted. Papers were excluded if they did not examine airway management in the prehospital cardiac arrest setting, involved the use of sedative or paralysing agents, involved paediatric patients, animals or cadavers. ResultsOf the 689 articles identified, 22 peer-reviewed articles were included for analysis. All 22 articles were from the following countries: America (3), America and Canada (1), Australia (2), Austria (1), Finland (1), Germany (4), Korea (1), Japan (4), The Netherlands (1), Norway (1), Taiwan (1), and United Kingdom (2). DiscussionThis review revealed large variances in both device effectiveness and patient outcome, particularly between geographical locations. Second-generation supraglottic airway devices demonstrated considerable improvement in effectiveness over their predecessors. Interestingly, the use of bag-valve mask ventilation reported better outcomes than any other form of advanced airway intervention. Studies also highlighted the diversity of airway management techniques and devices across global EMS systems. ConclusionDespite favourable indications of the effectiveness and safety of the next generation supraglottic airway devices, the paucity of prehospital-specific research (particularly randomised controlled trials) challenges decision making regarding prehospital airway management best practice.

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Section: Comparison Of Sad and Bvm Studiesmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Comparison Of Sad and Bvm Studiesmentioning

confidence: 97%

Section: Comparison Of Sad and Bvm Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Use of Supraglottic Airway Devices by Paramedics in the Management of Adult Prehospital Cardiac Arrest Patients

Barr

Smith

Darroch

2017

Australasian Journal of Paramedicine

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“…In addition, tracheal intubation leads to laryngeal edema, airway injury, and other complications. Hence, clinicians do not support tracheal intubation due to concerns over its safety and effectiveness [1].…”

Section: Introductionmentioning

confidence: 99%

Laryngeal mask versus endotracheal intubation for pre-hospital emergency airway management: a meta-analysis of randomized manikin and human studies

Li¹,

Duan²,

Zhang³

et al. 2019

Preprint

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Background Pre-hospital emergency airway management plays an important role in pre-hospital care. Laryngeal masks are increasingly employed for the airway management of pre-hospital critical patients and have achieved promising results. Although several randomized controlled trials have reported benefits, the efficacy of laryngeal masks in pre-hospital emergency airway management compared to endotracheal intubation have not been systematically reviewed.Methods Electronic databases (PubMed, Cochrane Library, Embase, Scopus and CNKI) were searched up to April 2019 for related randomized studies. Outcome indicators were overall intubation success rates, success rates of the initial intubation, insertion time, ventilation efficiency rates, SpO2 rise time and blood gas index. Two investigators selected the trials, extracted the data according to inclusion and exclusion criteria, and assessed the quality of the literature according to the Jada score. The meta-analysis was performed using stata14.0 software.Results We included 9 randomized manikin studies and 31 human studies. Meta-analysis of the manikin studies showed that the overall intubation success rates of the laryngeal mask group [RR=1.10, 95% CI (1.02, 1.18), P<0.05] and the success rates of first intubation [RR=1.25, 95% CI (1.01, 1.55), P <0.05] were significantly higher than the endotracheal intubation group. The insertion time of the laryngeal mask group was also significantly shorter [SMD = -1.53, 95% CI (-1.88, -1.17), P <0.05]. In human studies, excluding the success rates of first intubation and insertion time, the laryngeal mask was superior to endotracheal intubation and improved the patients’ blood gas index and shortened the SpO2 rise time. All the results were statistically significant.Conclusions Compared to endotracheal intubation, laryngeal masks could quickly and effectively improve patient ventilation in pre-hospital emergencies, highlighting its utility for clinical application .

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A review of ventilation in adult out‐of‐hospital cardiac arrest

et al. 2020

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Out‐of‐hospital cardiac arrest continues to be a devastating condition despite advances in resuscitation care. Ensuring effective gas exchange must be weighed against the negative impact hyperventilation can have on cardiac physiology and survival. The goals of this narrative review are to evaluate the available evidence regarding the role of ventilation in out‐of‐hospital cardiac arrest resuscitation and to provide recommendations for future directions. Ensuring successful airway patency is fundamental for effective ventilation. The airway management approach should be based on professional skill level and the situation faced by rescuers. Evidence has explored the influence of different ventilation rates, tidal volumes, and strategies during out‐of‐hospital cardiac arrest; however, other modifiable factors affecting out‐of‐hospital cardiac arrest ventilation have limited supporting data. Researchers have begun to explore the impact of ventilation in adult out‐of‐hospital cardiac arrest outcomes, further stressing its importance in cardiac arrest resuscitation management. Capnography and thoracic impedance signals are used to measure ventilation rate, although these strategies have limitations. Existing technology fails to reliably measure real‐time clinical ventilation data, thereby limiting the ability to investigate optimal ventilation management. An essential step in advancing cardiac arrest care will be to develop techniques to accurately and reliably measure ventilation parameters. These devices should allow for immediate feedback for out‐of‐hospital practitioners, in a similar way to chest compression feedback. Once developed, new strategies can be established to guide out‐of‐hospital personnel on optimal ventilation practices.

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Use of an intubating laryngeal mask airway on out-of-hospital cardiac arrest patients in a developing emergency medical service system

Abstract: Well-trained EMTs were able to insert the ILMA and ventilate OHCA patients properly in prehospital settings, and ILMA-treated OHCA patients had better short-term outcomes than BVM-treated patients.

Cited by 11 publications

References 27 publications

Use of Supraglottic Airway Devices by Paramedics in the Management of Adult Prehospital Cardiac Arrest Patients

Use of Supraglottic Airway Devices by Paramedics in the Management of Adult Prehospital Cardiac Arrest Patients

Laryngeal mask versus endotracheal intubation for pre-hospital emergency airway management: a meta-analysis of randomized manikin and human studies

A review of ventilation in adult out‐of‐hospital cardiac arrest

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