Clinical evaluation of the use of laryngeal tube versus laryngeal mask airway for out-of-hospital cardiac arrest by paramedics in Singapore

Abstract

INTRODUCTION It remains unclear which advanced airway device has better placement success and fewer adverse events in out-of-hospital cardiac arrests (OHCAs). This study aimed to evaluate the efficacy of the VBM laryngeal tube (LT) against the laryngeal mask airway (LMA) in OHCAs managed by emergency ambulances in Singapore. METHODS This was a real-world, prospective, cluster-randomised crossover study. All OHCA patients above 13 years of age who were suitable for resuscitation were randomised to receive either LT or LMA. The primary outcome was placement success. Per-protocol analysis was performed, and the association between outcomes and airway device group was compared using multivariate binomial logistic regression analysis. RESULTS Of 965 patients with OHCAs from March 2016 to January 2018, 905 met the inclusion criteria, of whom 502 (55.5%) were randomised to receive LT while 403 (44.5%) were randomised to receive LMA. Only 174 patients in the LT group actually received the device owing to noncompliance. Placement success rate for LT was lower than for LMA (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31–0.90). Complications were more likely when using LT (OR 2.82,0 95% CI 1.64–4.86). Adjusted OR for prehospital return of spontaneous circulation (ROSC) was similar in both groups. A modified intention-to-treat analysis showed similar outcomes to the per-protocol analysis between the groups. CONCLUSION LT was associated with poorer placement success and higher complication rates than LMA. The likelihood of prehospital ROSC was similar between the two groups. Familiarity bias and a low compliance rate to LT were the main limitations of this study.

Inserção da máscara laríngea por enfermeiros: revisão integrativa da literatura

“…A inserção de ML por médicos minimamente treinados e enfermeiras sem experiência anterior foram igualmente eficientes na colocação de ML e não apresentaram diferenças significativas no número de tentativas para o sucesso (36) . Convergem com esses resultados, outros estudos que apresentam achados positivos do uso de ML por diferentes operadores (44,45) . O que demonstra a facilidade no uso da ML por diferentes classes profissionais e, mesmo leitos.…”

“…A mesma foi usada em dois estudos que tratavam do manejo de PCREH (30,34) , nos quais foi observada ventilação bemsucedida, respectivamente, 85,38% e 96,0% dos casos. Em consonância com esses resultados positivos, está outro estudo realizado sobre o manejo de PCREH, o qual encontrou 89,4% de colocação bem-sucedida de ML (44) .…”

“…A presença de vazamentos ocorreu mais frequentemente, correspondendo a 25,61% com volumes mínimos e 8,46% com grandes volumes (30) , essa situação foi evidenciada, também em outros estudos com uma taxa de 0,5% (44) . Quanto aos outros efeitos adversos, um dos estudos registrou ausência de insuflação gástrica no uso da ML (31) .…”

Airway management in cardiac arrest and outcomes. Author’s reply

“…Secondary outcomes included the duration of the interruption of chest compression during ETI, Laryngeal view during intubation using Cormack-Lehane grade system, and self-reported percentage of glottis opening score Macintosh required longer time for ETI than Vie-Scope, and less first attempt success rate Cereceda-Sánchez et al [ 9 ] RCT, pilot Inclusion criteria: adults ≥ 18, years or older with OHCA who received resuscitation performed by clinicians from participating centers. Exclusion criteria: advanced airways, weight > 50 kg, oral cavity < 2 cm BMV vs. i-Gel 4 EM services 23 (9 BMV, 14 i-Gel) Comparison between BMV and i-Gel on capnometry and survival i-Gel group survived more than BMV group Chan et al [ 10 ] RCT, cluster, cross-over Inclusion criteria: all patients with OHCAs aged over 13 years, both medical and traumatic. Exclusion criteria: patients who did not meet the criteria for resuscitation by paramedics LMA vs. LT 1 EM service 905 (502 LT, 403 LMA) The primary outcome was placement success, and the secondary outcomes were complication rates and the presence of prehospital ROSC Placement success rate for LT was lower than for LMA.…”