Safety and Feasibility of the Laryngeal Tube When Used by EMTs During Out-of-Hospital Cardiac Arrest

Roth, Dominik von; Hafner, Christina; Aufmesser, Werner; Hudabiunigg, K; Wutti, C.; Herkner, Harald; Schreiber, Wolfgang

doi:10.1016/j.ajem.2015.04.048

Cited by 17 publications

(15 citation statements)

References 30 publications

(30 reference statements)

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“…After training, 66.7% of EMTs in our study appraised LT ventilation as being highly efficient. This corresponds with findings made in other studies of LT ventilation administered by EMTs and nurses showing success rates between 72 and 94% [ 1 , 3 – 5 , 11 ]. Although most EMTs in our study had only basic experience (fewer than ten LT insertions), they more often cited good ease of handling and fewer problems as compared to BVM.…”

Section: Discussionsupporting

confidence: 91%

“…Supraglottic airways including the laryngeal tube (LT) enable rapid and effective ventilation in most cases [ 1 ]. Contrarily, conventional bag-valve-mask (BVM) ventilation and endotracheal intubation may be difficult, especially when caregivers have little experience.…”

Section: Introductionmentioning

confidence: 99%

“…The promoted simplicity in handling makes the LT an attractive device for airway management during cardiopulmonary resuscitation (CPR), even for healthcare providers with only basic training [ 2 ]. Success rates after short training on manikins were reported between 72% and 94% in emergency medical technicians (EMTs) [ 1 , 3 – 5 ]. Kurola et al observed that the LT may enable rapid and effective airway control as compared to BVM when used by inexperienced personnel [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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

Fiala

Lederer

Neumayr

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundLaryngeal tube (LT) application by rescue personnel as an alternate airway during the early stages of out-of-hospital cardiac arrest (OHCA) is still subject of debate. We evaluated ease of handling and efficacy of ventilation administered by emergency medical technicians (EMTs) using LT and bag-valve-mask (BVM) during cardiopulmonary resuscitation of patients with OHCA.MethodsAn open prospective randomized multicenter study was conducted at six emergency medical services centers over 18 months. Patients in OHCA initially resuscitated by EMTs were enrolled. Ease of handling (LT insertion, tight seal) and efficacy of ventilation (chest rises visibly, no air leak) with LT and BVM were subjectively assessed by EMTs during pre-study training and by the attending emergency physician on the scene. Outcome and frequency of complications were compared.ResultsOf 97 eligible patients, 78 were enrolled. During pre-study training EMTs rated efficacy of ventilation with LT higher than with BVM (66.7% vs. 36.2%, p = 0.022), but efficacy of on-site ventilation did not differ between the two groups (71.4% vs. 58.5%, p = 0.686). Frequency of complications (11.4% vs. 19.5%, p = 0.961) did not differ between the two groups.ConclusionsEMTs preferred LT ventilation to BVM ventilation during pre-study training, but on-site there was no difference with regard to efficacy, ventilation safety, or outcome. The results indicate that LT ventilation by EMTs during OHCA is not superior to BVM and cannot substitute for BVM training. We assume that the main benefit of the LT is the provision of an alternative airway when BVM ventilation fails. Training in BVM ventilation remains paramount in EMT apprenticeship and cannot be substituted by LT ventilation.Trial registration ClinicalTrials.gov (NCT01718795).Electronic supplementary materialThe online version of this article (10.1186/s13049-017-0446-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Fiala

Lederer

Neumayr

et al. 2017

Scand J Trauma Resusc Emerg Med

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“…The success rates for the LT group did not include the twice-failed insertion attempts of the LT to BVM group (Table 5). There was a high incidence of adverse effects throughout all groups, consisting of regurgitation, airway injury or cuff rupture ( Table 5) (26). Successful ventilation was self-reported by the attending operators (EMTs who placed the device and an emergency physician that managed the patient afterward) and varied widely between the groups (26).…”

Section: Comparison Of Sad and Bvm Studiesmentioning

confidence: 99%

“…There was a high incidence of adverse effects throughout all groups, consisting of regurgitation, airway injury or cuff rupture ( Table 5) (26). Successful ventilation was self-reported by the attending operators (EMTs who placed the device and an emergency physician that managed the patient afterward) and varied widely between the groups (26). Both studies have the potential of self-reporting bias, and both are restricted by limited training and relatively inexperienced operators (26,27).…”

Section: Comparison Of Sad and Bvm Studiesmentioning

confidence: 99%

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

Barr

Smith

Darroch

2017

Australasian Journal of Paramedicine

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IntroductionCurrent best practice for paramedic airway management of prehospital cardiac arrest is being continually reviewed following changes to the emphasis on intubation as a primary intervention within international resuscitation guidelines. Subsequently, there is increased enthusiasm for the use of next generation supraglottic airway devices. This review aimed to identify the current evidence for the safety and effectiveness of supraglottic airways for the management of prehospital cardiac arrest. MethodsA search of the electronic databases Medline, PubMed, Science Direct and Cochrane Library was conducted. Papers were excluded if they did not examine airway management in the prehospital cardiac arrest setting, involved the use of sedative or paralysing agents, involved paediatric patients, animals or cadavers. ResultsOf the 689 articles identified, 22 peer-reviewed articles were included for analysis. All 22 articles were from the following countries: America (3), America and Canada (1), Australia (2), Austria (1), Finland (1), Germany (4), Korea (1), Japan (4), The Netherlands (1), Norway (1), Taiwan (1), and United Kingdom (2). DiscussionThis review revealed large variances in both device effectiveness and patient outcome, particularly between geographical locations. Second-generation supraglottic airway devices demonstrated considerable improvement in effectiveness over their predecessors. Interestingly, the use of bag-valve mask ventilation reported better outcomes than any other form of advanced airway intervention. Studies also highlighted the diversity of airway management techniques and devices across global EMS systems. ConclusionDespite favourable indications of the effectiveness and safety of the next generation supraglottic airway devices, the paucity of prehospital-specific research (particularly randomised controlled trials) challenges decision making regarding prehospital airway management best practice.

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Airway and Ventilation During Cardiopulmonary Resuscitation

Gough

Nolan

2017

Annual Update in Intensive Care and Emergency Medicine

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Safety and Feasibility of the Laryngeal Tube When Used by EMTs During Out-of-Hospital Cardiac Arrest

Cited by 17 publications

References 30 publications

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

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

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

Airway and Ventilation During Cardiopulmonary Resuscitation

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