Skip to main content Accessibility help
×
Home

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

  • Michael J. Murray (a1), Marian J. Vermeulen (a2), Laurie J. Morrison (a2) (a3) and Tim Waite (a4)

Abstract:

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.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

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

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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

Copyright

Corresponding author

Royal Victoria Hospital, Base Hospital Program, c/o Paramedic Services, Drury House, 60 Wellington St. W, Barrie ON L4N 1K4; MurrayM@rvh.on.ca

References

Hide All
1.Baskett, PJF.The laryngeal mask in resuscitation [editorial]. Resuscitation 1994;28:935.
2.Davies, PRF, Tighe, SQM, Greenslade, GL, Evans, GH.Laryngeal mask airway and tracheal tube insertion by unskilled personnel. Lancet 1990;336:9779.
3.Lawes, EG, Baskett, PJF.Pulmonary aspirations during unsuccessful cardiopulmonary resuscitation. Intensive Care Medicine 1987;13:37982.
4.The use of the laryngeal mask airway by nurses during cardiopulmonary resuscitation. Results of a multicentre trial. Anaesthesia 1994;49:37.
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;24:2603.
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):2314.
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):110.
8.Tanigawa, K, Shigematsu, A.Choice of airway devices for 12,020 cases of nontraumatic cardiac arrest in Japan. Prehosp Emerg Care 1998;2:96100.
9.Dickinson, M, Curry, P.Training for the use of the laryngeal mask in emergency and resuscitation situations. Resuscitation 1994;28:1113.
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):2247.
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;20:13148.
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):10326.
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;283:78390.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed