Prehospital use in emergency patients of a laryngeal mask airway by ambulance paramedics is a safe and effective alternative for endotracheal intubation

Abstract

BackgroundIn Dutch ambulance practice, failure or inability to intubate patients with altered oxygenation and/or ventilation leaves bag-valve mask ventilation as the only alternative, which is undesirable for patient outcome. A novel Laryngeal Mask Airway Supreme (LMA-S) device may be a suitable alternative.AimTo evaluate the effectiveness and suitability of the LMA-S for emergency medical services in daily out-of-hospital emergency practice.MethodsAfter a period of theoretical and practical training of ambulance paramedics in the use of the LMA-S, prospective data were collected on the utilisation of LMA-S in an observational study. Procedures for use were standardised and the evaluation included the number of direct intubation attempts before using LMA-S, attempts required, failure rate and the adequacy of ventilation. Data were analysed taking patient characteristics such as age and indication for ventilatory support into account.ResultsThe LMA-S was used 50 times over a period of 9 months (33 involving cardiorespiratory arrest, 14 primary and three rescue). The LMA-S could be applied successfully in all 50 cases (100%) and was successful in the first attempt in 49 patients (98%). Respiratory parameters showed adequate oxygenation. All paramedics were unanimously positive about the utilisation of LMA-S because of the easiness of the effort of insertion and general use, and emphasised its value as a useful resource for patients in need.ConclusionsEnsuring ventilation support by using LMA-S by paramedics in prehospital emergency practice is safe and effective.

A prospective randomised comparison of two insertion methods for i-gel™placement in anaesthetised paralysed patients: standard vs rotational technique

“…The i-gel is widely used for airway management in emergency situations, especially outside hospital [1][2][3][4]. It is important to insert the i-gel at the first attempt to secure the airway and provide adequate oxygenation.…”

“…This device has been used for routine elective anaesthesia and has also been shown to be effective in pre-hospital emergency airway management [1][2][3][4]. The i-gel can also be used as a conduit for fibreoptic bronchoscopy-guided tracheal intubation in patients with difficult airways [5][6][7].…”

Use of Supraglottic Airway Devices by Paramedics in the Management of Adult Prehospital Cardiac Arrest Patients

“…Current research is providing contradictory evidence for the use of SADs during OHCAs (1,12), furthermore, there remains a degree of uncertainty as to which airway management device provides the most favourable outcomes in the prehospital setting.…”

State-of-the-art paediatric airway management

“…The laryngeal mask airway (LMA) is an ideal tool in certain paediatric airway scenarios, including an airway that could be managed without tracheal intubation or in a situation where the operator is unable to intubate the patient 13 . The LMA comes in various sizes based on weight range.…”