scholarly journals Which is more effective for ventilation in the prehospital setting during cardiopulmonary resuscitation, the laryngeal mask airway or the bag-valve-mask? - A review of the literature

2010 ◽  
Vol 8 (3) ◽  
Author(s):  
Emma Flavell ◽  
Malcolm Boyle
Keyword(s):  
Laryngeal Mask Airway ◽  
Cardiopulmonary Resuscitation ◽  
Prehospital Care ◽  
Prehospital Setting ◽  
Laryngeal Mask ◽  
Cochrane Central Register ◽  
Care Providers ◽  
Airway Patency ◽  
Gastric Regurgitation ◽  
Over Time

Introduction Prehospital care providers are responsible for providing adequate ventilation during cardiopulmonary resuscitation (CPR). Endotracheal intubation (ETI) is widely accepted as the 'gold standard' for airway protection and the preferred method for ventilation. However, most Australian paramedics are not trained to perform ETI. Laryngeal Mask Airway (LMA) and Bag-Valve-Mask (BVM) are seen as adequate alternatives to ETI as recommended by the International Liaison Committee of Resuscitation (ILCOR). The objective of this study was to identify which airway device LMA or BVM (with OPA/NPA) is more effective in airway patency and ventilation during cardiopulmonary resuscitation in the prehospital environment. Methods A literature search was conducted using medical electronic databases, MEDLINE CINHAL, EMBASE, Meditext, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus. These databases were searched from January 1996 until the end of January 2010. Articles were included if the principal objective was to compare ventilation efficiency of the LMA against the BVM in the prehospital setting. References from articles retrieved were reviewed. Results There were 2937 articles located by the search. Of these, 30 articles met the inclusion criteria with twelve relevant to the prehospital environment. In the twelve prehospital studies, two involved the use of mannequins, four were retrospective, five were observational, and there was one a literature review. Conclusion The findings from this review suggest that the LMA is more effective at ventilations over time during CPR in adults, as there is less risk of gastric regurgitation and pulmonary aspiration. The BVM is quicker at performing the first ventilation but there is a loss of effectiveness over time. BVM is considered the best method for ventilating children and neonates.

Abstract 59: The Incidence Of Pulmonary Aspiration With Laryngeal Mask Airway Use During Cardiopulmonary Resuscitation And Positive Pressure Ventilation In Swine.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Brian Suffoletto ◽  
James Menegazzi ◽  
Eric Logue ◽  
David Salcido
Keyword(s):  
Laryngeal Mask Airway ◽  
Cardiopulmonary Resuscitation ◽  
Positive Pressure Ventilation ◽  
Validation Cohort ◽  
Pulmonary Aspiration ◽  
Laryngeal Mask ◽  
Positive Pressure ◽  
Suction Catheter ◽  
Chest Compressions ◽  
Lung Expansion

Objective: Pulmonary aspiration of gastric contents occurs 20 –30% of the time during cardiopulmonary resuscitation (CPR) of cardiac arrest. This is due to loss of protective airway reflexes, pressure changes generated during CPR, and positive pressure ventilation (PPV). Even though the American Heart Association (AHA) has recommended the laryngeal mask airway (LMA) as an acceptable alternative airway for use by EMS personnel, concerns over the capacity of the device to protect from pulmonary aspiration remain. We sought to determine the incidence of aspiration after LMA placement, CPR and PPV. Methods: We conducted a prospective study on 16 consecutive post-experimental mixed-breed domestic swine of either sex (mean mass 25.7 ±1.4 kgs). A standard size-4 LMA was modified so that a vacuum catheter could be advanced into and past the LMA diaphragm. The LMA was placed into the hypopharynx and its position confirmed using End-tidal CO 2 and direct visualization of lung expansion. Fifteen milliliters of heparinized blood were instilled into the pharynx. After 5 PPVs with a mechanical ventilator, chest compressions were performed for 60s with asynchronous ventilations continuing at a rate of 12 per minute. After chest compressions, a suction catheter was inserted through the cuff and suction applied for approximately 1 minute. The catheter was removed and inspected for signs of blood. The LMA cuff was deflated and the LMA removed. The intima of the LMA diaphragm was inspected for signs of blood. In a validation cohort of 4 animals, the LMA was reinserted, a cricothyrotomy performed and 5 mL of blood instilled directly into the trachea. Results: There were 0/16 (95% CI=0 –17%) with a positive tests for the presence of blood in both the vacuum catheter and the intima of the LMA diaphragm. In the validation cohort, all four were positive for blood in both the vacuum catheter and the intima of the LMA diaphragm. Conclusions: In this simple model of regurgitation of after LMA placement, there was no sign of pulmonary aspiration, and no evidence that blood had passed beyond the seal created by the LMA cuff. Concerns over aspiration with LMA use may be unfounded. Future studies should determine the frequency of pulmonary aspiration after LMA placement in the clinical setting.

scholarly journals Gastric rupture associated with use of the laryngeal mask airway during cardiopulmonary resuscitation

BMJ ◽  
2004 ◽  
Vol 329 (7476) ◽  
pp. 1225-1226 ◽  
Author(s):  
Nathaniel Haslam ◽  
G Claire Campbell ◽  
John E Duggan
Keyword(s):  
Laryngeal Mask Airway ◽  
Cardiopulmonary Resuscitation ◽  
Laryngeal Mask ◽  
Gastric Rupture

scholarly journals Effect of inhaled carbon dioxide on laryngeal abduction

2015 ◽  
Vol 118 (4) ◽  
pp. 489-494 ◽  
Author(s):  
Jonathan Cheetham ◽  
Amanda Jones ◽  
Manuel Martin-Flores
Keyword(s):  
Laryngeal Mask Airway ◽  
High Speed ◽  
Upper Airway ◽  
Laryngeal Mask ◽  
Maximal Response ◽  
High Temporal Resolution ◽  
Respiratory Drive ◽  
Laryngeal Function ◽  
Airway Patency ◽  
End Tidal

Hypercapnia produces a profound effect on respiratory drive and upper airway function to maintain airway patency. Previous work has evaluated the effects of hypercapnia on the sole arytenoid abductor, the posterior cricoarytenoid (PCA), using indirect measures of function, such as electromyography and direct nerve recording. Here we describe a novel method to evaluate PCA function in anesthetized animals and use this method to determine the effects of hypercapnia on PCA function. Eight dogs were anesthetized, and a laryngeal mask airway was used, in combination with high-speed videoendoscopy, to evaluate laryngeal function. A stepwise increase in inspired partial pressure of CO2 produced marked arytenoid abduction above 70-mmHg end-tidal CO2 (ETCO2) ( P < 0.001). Glottic length increased above 80-mmHg ETCO2 ( P < 0.02), and this lead to underrepresentation of changes in glottic area, if standard measures of glottic area (normalized glottic gap area) were used. Use of a known scale to determine absolute glottic area demonstrated no plateau with increasing ETCO2 up to 120 mmHg. Ventilatory parameters also continued to increase with no evidence of a maximal response. In a second anesthetic episode, repeated bursts of transient hypercapnia for 60 s with an ETCO2 of 90 mmHg produced a 43–55% increase in glottic area ( P < 0.001) at or shortly after the end of the hypercapnic burst. A laryngeal mask airway can be used in combination with videoendoscopy to precisely determine changes in laryngeal dimensions with high temporal resolution. Absolute glottic area more precisely represents PCA function than normalized glottic gap area at moderate levels of hypercapnia.

scholarly journals Prehospital Use of the Intubating Laryngeal Mask Airway in Patients with Severe Polytrauma: A Case Series

2009 ◽  
Vol 2009 ◽  
pp. 1-7 ◽  
Author(s):  
Andrew M. Mason
Keyword(s):  
Laryngeal Mask Airway ◽  
Tracheal Intubation ◽  
Road Traffic ◽  
Case Series ◽  
Prehospital Setting ◽  
Laryngeal Mask ◽  
Probability Of Survival ◽  
Survival Study ◽  
Intubating Laryngeal Mask Airway ◽  
Better Than

A case series of five patients is described demonstrating the utility of the intubating laryngeal mask airway in the prehospital setting, both as a primary airway rescue device and as a bridge to tracheal intubation. All patients were hypoxaemic, had sustained severe polytrauma and were trapped in their vehicles following road traffic collisions. A probability of survival study showed better-than-predicted outcomes for the group as a whole.

The role of laryngeal mask airway in cardiopulmonary resuscitation

Resuscitation ◽  
1994 ◽  
Vol 28 (2) ◽  
pp. 103-106 ◽  
Author(s):  
Abdulhamid H. Samarkandi ◽  
Mohamed A. Seraj ◽  
Abdelazeem El Dawlatly ◽  
Muntimadugn Mastan ◽  
Hassan B. Bakhamees
Keyword(s):  
Laryngeal Mask Airway ◽  
Cardiopulmonary Resuscitation ◽  
Laryngeal Mask
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