A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children

Abstract

In adults, first responders to a cardiopulmonary arrest provide better ventilation using a laryngeal mask airway than a facemask. It is unclear if the same is true in children. We investigated this by comparing the ability of 36 paediatric ward nurses to ventilate the lungs of 99 anaesthetised children (a model for cardiopulmonary arrest) using a laryngeal mask airway and using a facemask with an oropharyngeal airway. Anteroposterior chest wall displacement was measured using an ultrasonic detector. Nurses achieved successful ventilation in 74 (75%) of cases with the laryngeal mask airway and 76 (77%) with facemask and oropharyngeal airway (p = 0.89). Median (IQR [range]) time to first breath was longer for the laryngeal mask airway (48 (39-65 [8-149])) s than the facemask ⁄ airway (35 (25-53 [14-120]) s; p < 0.0001). In 10 cases (10%) the lungs were ventilated using the laryngeal mask airway but not using the facemask ⁄ oropharyngeal airway. We conclude that ventilation is achieved rapidly using a facemask and oropharyngeal airway, and that the laryngeal mask airway may represent a useful second line option for first responders. The laryngeal mask airway (LMA) has been advocated as a device for airway management during the resuscitation of adults following cardiopulmonary arrest [1] but its role in the resuscitation of children is less clear. Tracheal intubation, the gold standard for securing the airway, is a difficult skill to acquire and maintain and can lead to further complications if an unsuccessful intubation is not recognised [2,3]. In contrast, insertion of the LMA can be learnt quickly and easily by inexperienced personnel [2, 4-6]; however, the LMA is not currently recommended for first line airway management in children requiring resuscitation [7].In an attempt to establish the utility of the LMA during resuscitation of children by first responders untrained in tracheal intubation, we have previously studied paediatric critical care nurses [8]. Their ability to ventilate the lungs of an apnoeic, anaesthetised child using an LMA was compared with that using a facemask and oropharyngeal airway. We found no difference in the efficacy of ventilation between the two methods; however, ventilation with the LMA took significantly longer to achieve. Two main limitations of that study are first, the practitioners were relatively experienced with facemask ventilation and as such may not be representative of first responders to cardiopulmonary arrests in children. Second, the method of LMA insertion that was taught was the method advocated by Brain in adults and this may not be optimal, studies having shown that the lateral insertion technique has a higher success rate in children [9][10][11].In view of these limitations we have repeated our randomised crossover trial, comparing the LMA with the facemask and oropharyngeal airway for manual ventilation of the lungs of apnoeic anaesthetised children. We studied ward based paediatric nurses as our cohort of practitioners as we felt their skills were more likely to...

Part 10: Pediatric Basic and Advanced Life Support

“…In 2 LOE 5 studies of anesthetized children 145,146 suitably trained ICU and ward nurses placed LMAs with a high success rate, although time to first breath was shorter in the BMV group. In a small number of cases ventilation was achieved with an LMA when it proved impossible with BMV.…”

A comparison of three supraglottic airway devices used by healthcare professionals during paediatric resuscitation simulation

“…Cook et al reported that the most frequent reason for suboptimal ventilation with the LMA was an imperfect seal 16. Because successful insertion of the LMA varied by professional group in the present study, the optimal insertion in our study of the LMA seems to be experience-dependent; however, there are two relevant studies by Rechner et al and Blevin et al that showed good success rates for the use of the LMA by inexperienced healthcare workers in children when the LMA and facemask ventilation were compared 11 12. Furthermore, the variability of the success rate in the use of the LMA in our groups could be explained by the different techniques for LMA insertion which were not limited in the present study 8 9…”

“…However, it must be noted that the first-line method of attaining airway control in children is bag-mask ventilation because successful airway management in children requires a high level of skill and regular training 1 11 12. Nevertheless, SADs, such as the LMA, LTS and I-gel, are recognised as possible alternatives to achieve airway control in a paediatric emergency.…”

Singapore Paediatric Resuscitation Guidelines 2016

“…(41) In the prehospital environment, based on the limited paediatric literature available, bag-valve-mask should be used for initial airway management. However, if there are issues ventilating a critically ill or collapsed paediatric patient, it is reasonable to use appropriate supraglottic devices, especially laryngeal masks, as a rescue device in conjunction with bag-valve-mask.…”