EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial

Fiala, Anna E.; Lederer, Wolfgang; Neumayr, Agnes; Egger, T.; Neururer, Sabrina; Toferer, Ernst; Baubin, Michael; Paal, Peter

doi:10.1186/s13049-017-0446-1

Cited by 28 publications

(18 citation statements)

References 21 publications

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“…In addition, Fiala et al found no difference between BMV and the LT for ventilating OHCA patients in a multicenter randomized study of EMT-led airway management. 14,15 Considering other EGDs, our findings are also consistent with multiple prior studies of inexperienced providers using laryngeal mask airways (LMA), all of which concluded that inexperienced airway providers (including nurses, nursing students, dental students, and other volunteers with no prior experience) can provide better ventilation with the LMA than with BMV (with or without a concomitant oropharyngeal airway). 5,[22][23][24][25][26] One study looking specifically at obese patients found that medical students were able to establish effective ventilation more quickly with the LMA than with BMV.…”

Section: Discussionsupporting

confidence: 89%

“…Studies examining minute ventilation as well as those using a subjective outcome of "adequate ventilation" as judged by the care provider have yielded conflicting results when examining the efficacy of LT versus BMV. 3,8,14,15 We therefore aimed to compare ventilation efficacy of inexperienced airway providers with BMV versus LT on a simulated model. Our primary outcome was measured tidal volume, and our secondary outcome was peak pressure.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Laryngeal Tube versus Bag Mask Ventilation by Inexperienced Providers

Hart

Kartha

Reardon

et al. 2020

WestJEM

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Introduction: Bag mask ventilation (BMV) and extraglottic devices (EGDs) are two common methods of providing rescue ventilation. BMV can be difficult to perform effectively, especially for inexperienced providers and in patients with difficult airway characteristics. There is some evidence that the laryngeal tube (LT) can be successfully placed by inexperienced providers to provide effective ventilation. However, it is unclear whether ventilation provided by LT is superior to that of BMV, especially in the hands of inexperienced airway providers. Therefore, we aimed to compare ventilation efficacy of inexperienced airway providers with BMV versus LT by primarily measuring tidal volumes and secondarily measuring peak pressures on a simulated model. Methods: We performed a crossover study first year emergency medicine residents and third and fourth year medical students. After a brief instructional video followed by hands on practice, participants performed both techniques in random order on a simulated model for two minutes each. Returned tidal volumes and peak pressures were measured. Results: Twenty participants were enrolled and 1200 breaths were measured, 600 per technique. The median ventilation volumes were 194 milliliters (mL) for BMV, and 387 mL for the laryngeal tube, with a median absolute difference of 170 mL (95% confidence interval [CI] 157-182 mL) (mean difference 148 mL [95% CI, 138-158 mL], p<0.001). The median ventilation peak pressures were 23 centimeters of water (cm H 2 O) for BMV, and 30 cm H 2 O for the laryngeal tube, with a median absolute difference of 7 cm H 2 O (95% CI, 6-8 cm H2O) (mean difference 8 cm H 2 O [95% CI, 7-9 cm H 2 O], p<0.001). Conclusion: Inexperienced airway providers were able to provide higher ventilation volumes and peak pressures with the LT when compared to BMV in a manikin model. Inexperienced providers should consider using an LT when providing rescue ventilations in obtunded or hypoventilating patients without intact airway reflexes. Further study is required to understand whether these findings are generalizable to live patients. [

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Efficacy of Laryngeal Tube versus Bag Mask Ventilation by Inexperienced Providers

Hart

Kartha

Reardon

et al. 2020

WestJEM

View full text Add to dashboard Cite

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“…To improve OHCA outcomes, many countries are applying various strategies to their emergency medical services (EMS) 123. Previous reports of prehospital EMS interventions, including dispatch type, airway management, and the number of emergency medical technicians (EMTs) have been reported 4567891011. Among these, multi-dispatch response to an OHCA, using more than two EMS teams of the same or different tiers, have shown some positive effects 67111213.…”

Section: Introductionmentioning

confidence: 99%

Application of a Dual-Dispatch System for Out-of-Hospital Cardiac Arrest Patients: Will More Hands Save More Lives?

et al. 2019

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Background Recovery after out-of-hospital cardiac arrest (OHCA) is difficult, and emergency medical services (EMS) systems apply various strategies to improve outcomes. Multi-dispatch is one means of providing high-quality cardiopulmonary resuscitation (CPR), but no definitive best-operation guidelines are available. We assessed the effects of a basic life support (BLS)-based dual-dispatch system for OHCA. Methods This prospective observational study of 898 enrolled OHCA patients, conducted in Daegu, Korea from March 1, 2015 to June 30, 2016, involved patients > 18 years old with suspected cardiac etiology OHCA. In Daegu, EMS started a BLS-based dual-dispatch system in March 2015, for cases of cardiac arrest recognition by a dispatch center. We assessed the association between dual-dispatch and OHCA outcomes using multivariate logistic regressions. We also analyzed the effect of dual-dispatch according to the stratified on-scene time. Results Of 898 OHCA patients (median, 69.0 years; 65.5% men), dual-dispatch was applied in 480 (53.5%) patients. There was no difference between the single-dispatch group (SDG) and the dual-dispatch group (DDG) in survival at discharge and neurological outcomes (survival discharge, P = 0.176; neurological outcomes, P = 0.345). In the case of less than 10 minutes of on-scene time, the adjusted odds ratio was 1.749 (95% confidence interval [CI], 0.490–6.246) for survival discharge and 6.058 (95% CI, 1.346–27.277) for favorable neurological outcomes in the DDG compared with the SDG. Conclusion Dual-dispatch was not associated with better OHCA outcomes for the entire study population, but showed favorable neurological outcomes when the on-scene time was less than 10 minutes.

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“…Effective ventilation is an important component in survival and is associated with return of spontaneous circulation (ROSC) and neurological recovery (1). However, the most optimal method for effective ventilation is still under debate (2).…”

Section: Introductionmentioning

confidence: 99%

Comparing the efficacy of bag-valve mask, endotracheal intubation, and laryngeal mask airway for subjects with out-of-hospital cardiac arrest: an indirect meta-analysis

Liang¹,

Qiu²,

He³

et al. 2019

Ann. Transl. Med

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Background: For subjects with out-of-hospital cardiac arrest (OHCA), bag-valve mask (BVM), endotracheal intubation (ETI), and laryngeal mask airway (LMA) are the most common methods of ventilatory support; however, the best choice remains controversial. Methods: A comprehensive search of online databases was performed. A traditional meta-analysis was performed to determine the risk ratio of BVM vs. LMA and ETI vs. LMA. Indirect treatment comparisons (ITCs) were conducted to compare BVM and ETI. Results: A total of 13 full-text articles reporting the efficacy of BVM, ETI, and LMA were considered in this analysis. BVM and LMA had the same effect regarding return of spontaneous circulation (ROSC) (23% vs. 24%; RR =0.84), survival rate at admission (19% vs. 21%; RR =0.82) or discharge (6% vs. 4%; RR =0.61). ETI was superior to LMA in terms of ROSC (48% vs. 23%; RR =0.72) and survival rate at both admission (27% vs. 19%; RR =0.85) and discharge (12% vs. 4%; RR =0.90). BVM was inferior to ETI in terms of ROSC (24% vs. 48%; RR =0.86), survival to admission rate (21% vs. 27%; RR =1.037), and survival to discharge rate (6% vs. 12%; RR =1.476). Conclusions: ETI should be considered for airway management as early as possible, which can improve the subject's success rate of recovery and survival to admission rate. In future, large-scale, multi-center, randomized controlled studies should be conducted to evaluate the exact efficacy of BVM, ETI, and LMA for the first aid of subjects with OHCA.

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EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial

Cited by 28 publications

References 21 publications

Efficacy of Laryngeal Tube versus Bag Mask Ventilation by Inexperienced Providers

Efficacy of Laryngeal Tube versus Bag Mask Ventilation by Inexperienced Providers

Application of a Dual-Dispatch System for Out-of-Hospital Cardiac Arrest Patients: Will More Hands Save More Lives?

Comparing the efficacy of bag-valve mask, endotracheal intubation, and laryngeal mask airway for subjects with out-of-hospital cardiac arrest: an indirect meta-analysis

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