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Chest compressions do not disrupt the seal created by the laryngeal mask airway during positive pressure ventilation: a preliminary porcine study

Published online by Cambridge University Press:  04 March 2015

Jestin N. Carlson ,
Brian P. Suffoletto ,
David D. Salcido ,
Eric S. Logue  and
James J. Menegazzi
Jestin N. Carlson*
Affiliation:
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA Department of Medicine, Division of Emergency Medicine, Saint Vincent Medical Center, Erie, PA
Brian P. Suffoletto
Affiliation:
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
David D. Salcido
Affiliation:
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
Eric S. Logue
Affiliation:
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
James J. Menegazzi
Affiliation:
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
*
Department of Emergency Medicine, University of Pittsburgh, 3600 Forbes Avenue, Suite 400A, Iroquois Bldg, Pittsburgh, PA 15213, carlsonjn@upmc.edu

Abstract

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Objective:

Pulmonary aspiration of gastric contents occurs 20 to 30% of the time during cardiopulmonary resuscitation (CPR) of cardiac arrest due to loss of protective airway reflexes, pressure changes generated during CPR, and positive pressure ventilation (PPV). Although the American Heart Association has recommended the laryngeal mask airway (LMA) as an acceptable alternative airway for use by emergency medical service personnel, concerns over the capacity of the device to protect from pulmonary aspiration remain.We sought to determine the occurrence of aspiration after LMA placement, CPR, and PPV.

Methods:

We inserted a size 4 LMA, modified so that a vacuum catheter could be advanced past the LMA diaphragm, into the hypopharynx of 16 consecutive postexperimental mixed-breed domestic swine. Fifteen millilitres of heparinized blood was instilled into the oropharynx. Chest compressions were performed for 60 seconds with asynchronous ventilation via a mechanical ventilator. We then suctioned through the LMA for 1 minute. The catheter was removed and inspected for signs of blood. The LMA cuff was deflated, removed, and inspected for signs of blood.

Results:

None of 16 animals (95% CI 0-17%) had a positive test for the presence of blood in both the vacuum catheter and the intima of the LMA diaphragm.

Conclusions:

In this swine model of regurgitation after LMA placement, there were no cases with evidence of blood beyond the seal created by the LMA cuff. Future studies are needed to determine the frequency of pulmonary aspiration after LMA placement during CPR and PPV in the clinical setting.

Keywords

cardiopulmonary resuscitationlaryngeal mask airwaypositive pressure ventilation
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 5 , September 2014 , pp. 378 - 382
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

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