Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-23T12:23:39.002Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of prehospital insertion of the laryngeal mask airway by primary care paramedics with only classroom mannequin training

Published online by Cambridge University Press:  21 May 2015

Michael J. Murray ,
Marian J. Vermeulen ,
Laurie J. Morrison  and
Tim Waite
Michael J. Murray
Affiliation:
Base Hospital Program, Department of Emergency Services, Royal Victoria Hospital, Barrie, Ont.
Marian J. Vermeulen
Affiliation:
Division of Prehospital Care, Department of Emergency Services, Sunnybrook and Women’s College Health Sciences Centre; Department of Health Administration, University of Toronto, Toronto, Ont.
Laurie J. Morrison
Affiliation:
Division of Prehospital Care, Department of Emergency Services, Sunnybrook and Women’s College Health Sciences Centre; Department of Health Administration, University of Toronto, Toronto, Ont. Division of Emergency Medicine, Department of Medicine, University of Toronto, and Toronto Emergency Medical Services, Toronto, Ont.
Tim Waite
Affiliation:
Base Hospital Program, Department of Emergency Services, Royal Victoria Hospital, Barrie, Ont.

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Introduction:

The laryngeal mask airway (LMA™ airway) provides adequate ventilation and offers a suitable alternative for airway management in patients with cardiac arrest if primary care paramedics do not have intubation skills or are unable to intubate. Training in the use of the LMA usually occurs in the operating room.

Objective:

To describe the use of the LMA by paramedics in prehospital adult non-traumatic cardiac arrest patients after classroom mannequin training. The study took place in a suburban rural emergency medical service.

Methods:

This is a 2-phase observational study of the effect of paramedic training for LMA insertion using a mannequin and the success rate in the prehospital setting. All paramedics successfully completed classroom mannequin training. All subsequent prehospital adult non-traumatic cardiac arrest patients from mid-February 1999 to Mar. 31, 2000, were eligible. Subjective assessment of chest expansion, ease of ventilation and auscultation defined adequacy of ventilation. Data collected included the number of insertion attempts, reasons for failure, ease of insertion, adverse events and reasons for not attempting intubation. Statistical analysis comprised descriptive frequencies, chi-squared tests for comparison of categorical variables and analysis of variance for continuous variables.

Results:

208 paramedics (100%) successfully completed training. The mean number of attempts was 1, and only 4 (2.1%) paramedics required a second attempt with a mannequin. The paramedics’ perception of ease of use comparing the LMA with a bag valve mask (BVM) was evenly distributed across the 3 descriptors: 70 (39%) scored the LMA as easier to use, 57 (31%) as more difficult, and 54 (30%) stated there would be no difference. Of the 291 arrests during the study period, insertion of the LMA was attempted in 283 (97.3%) and was successful in 199 (70%) patients. The LMA became dislodged in 5 (2.5%) cases and was removed in 12 (6%) to clear vomit from the airway. The overall success rate was 182 (64%). The incidence of regurgitation prior to attempted insertion of the LMA was 28% (79 patients). Success rates did not vary significantly with the incidence of vomiting prior to insertion (p = 0.11). The majority of the paramedics evaluated LMA insertion as Very easy 49/220 (22.3%) or Easy 87/220 (39.6%). Paramedic evaluation of ease of use varied with success (p = 0.001).

Conclusions:

This study reports a 100% training success rate with a mannequin and a 64% success with LMA insertion and ventilation in the field by paramedics among adult out-of-hospital non-traumatic cardiac arrest patients.

Keywords

emergency medical servicesairwayeducationcardiac arrest
Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 5 , September 2002 , pp. 338 - 343
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

References

1.Baskett, PJF.The laryngeal mask in resuscitation [editorial]. Resuscitation 1994;28:93–5.Google Scholar
2.Davies, PRF, Tighe, SQM, Greenslade, GL, Evans, GH.Laryngeal mask airway and tracheal tube insertion by unskilled personnel. Lancet 1990;336:977–9.Google Scholar
3.Lawes, EG, Baskett, PJF.Pulmonary aspirations during unsuccessful cardiopulmonary resuscitation. Intensive Care Medicine 1987;13:379–82.Google Scholar
4.The use of the laryngeal mask airway by nurses during cardiopulmonary resuscitation. Results of a multicentre trial. Anaesthesia 1994;49:3–7.Google Scholar
5.Reinhart, DJ, Simmons, G.Comparison of the placement of the laryngeal mask airway with endotracheal tube by paramedics and respiratory therapists. Ann Emerg Med 1994;24:260–3.Google Scholar
6.Alexander, R, Hodgson, P, Lomax, D, Bullen, C.A comparison of the laryngeal mask airway and Guedel airway, bag and facemask for manual ventilation following formal training. Anaesthesia 1993;48(3):231–4.CrossRefGoogle ScholarPubMed
7.Rumball, CJ, MacDonald, D.The PTL, Combitube, laryngeal mask, and oral airway: a randomized prehospital comparative study of ventilatory device effectiveness and cost effectiveness in 470 cases of cardiorespiratory arrest. Prehosp Emerg Care 1997;1(1):1–10.Google Scholar
8.Tanigawa, K, Shigematsu, A.Choice of airway devices for 12,020 cases of nontraumatic cardiac arrest in Japan. Prehosp Emerg Care 1998;2:96–100.Google Scholar
9.Dickinson, M, Curry, P.Training for the use of the laryngeal mask in emergency and resuscitation situations. Resuscitation 1994;28:111–3.Google Scholar
10.Larmon, B, Schriger, DL, Snelling, R, Morgan, MT.Results of a 4-hour endotracheal intubation class for EMT-basics. Ann Emerg Med 1998;31(2):224–7.Google Scholar
11.Stratton, SJ, Kane, G, Gunter, CS, Wheeler, C, Ableson-Ward, C, Reich, E, et al. Prospective study of manikin-only versus manikin and human subject endotracheal intubation training of paramedics. Ann Emerg Med 1991;20:1314–8.Google Scholar
12.Stewart, RD, Paris, PM, Pelton, GH, Garretson, D.Effect of varied training techniques on field endotracheal intubation success rates. Ann Emerg Med 1984;13(11):1032–6.CrossRefGoogle ScholarPubMed
13.Gausche, MRJ, Lewis, SJ, Stratton, BE, Haynes, CS, Gunter, SM, Goodrich, PD, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial. JAMA 2000;283:783–90.Google Scholar