The laryngeal mask airway

Abstract

SummaryTwo cases of emergency prehospital airway control using the laryngeal mask are described. The patients were trapped following road trafic accidents and limited access prevented tracheal intubation. The laryngeal mask airway may be a useful alternative to tracheal intubation in some cases of prehospital trauma care. Key wordsEquipment; laryngeal mask.The laryngeal mask was introduced by Brain in 1983 as a new item of equipment for the maintenance of the airway [I]. It can be inserted blind and may be used in spontaneously breathing patients or to permit intermittent positive pressure ventilation (IPPV). Although it is primarily used in routine anaesthesia [2] there have been reports of its use in emergency situations [3-51. We believe that these are the first case reports of the use of the laryngeal mask in prehospital trauma care. Case histories Case IA 21-year-old man was the front seat passenger in a car which suffered extensive front impact damage in a head-on collision. The driver was killed instantly. The patient was trapped in an upright position by his legs, pelvis and abdomen. He had a respiratory rate of less than 10 breath.min-', a weak pulse of 110 beat.min-I, and a Glasgow Coma Score of three. It was not possible to gain access to the patient in order to pass a tracheal tube. A laryngeal mask was passed from in front of the casualty, while his neck was supported in a cervical collar and assisted ventilation was successfully achieved using a bag attached to an oxygen reservoir. Following release of the patient, orotracheal intubation was attempted at the roadside but the vocal cords could not be visualised and there was considerable haemorrhage in the region of the posterior nasopharynx.A cricothyroidotomy was performed and the airway thereby secured and protected for transfer to hospital. This patient subsequently died from his thoracic and cerebral injuries. Patient 2A 32-year-old man was trapped by his lower limbs in a car. On examination, his airway was compromised by bleeding from severe facial fractures. His respiratory rate was 6 breath.min-I, his chest expansion was equal, he was pale and had a pulse rate of 120 beat.min-l. He was unresponsive to painful stimuli. Access to the casualty was limited by vehicle damage and attempts to control the airway and assist ventilation through an oropharyngeal airway using bag and mask technique were unsuccessful. A size 3 laryngeal mask was passed and artifical ventilation was successfully achieved. Intravenous fluids were administered and IPPV was continued during extrication of the patient, which took 30 min. Following release the patient's trachea was intubated at the roadside and he was transferred to hospital with controlled ventilation and a protected airway. After arrival in hospital he underwent emergency laparotomy and was found to have a severely lacerated liver. He died from overwhelming intra-abdominal haemorrhage which could not be controlled during surgery. DiscussionThe main objection to the use of the laryngeal mask in the emergency ...

Extrication of patients trapped following a motor vehicle collision: a systematic scoping review of the literature

“…A surprisingly large number of mannequin-based studies evaluated the use of a wide variety of laryngoscopes or supraglottic airway devices for the placement of endotracheal tubes in entrapped mannequins in various positions [101–115]. Individual case studies and small case series supported the use of supraglottic airway devices in extremis [116–118]. A single retrospective chart review of airway management published as an abstract recognised the challenges of intubation in the entrapped patient [119].…”

“…A surprisingly large number of mannequin-based studies evaluated the use of a wide variety of laryngoscopes or supraglottic airway devices for the placement of endotracheal tubes in entrapped mannequins in various positions [101][102][103][104][105][106][107][108][109][110][111][112][113][114][115]. Individual case studies and small case series supported the use of supraglottic airway devices in extremis [116][117][118]. A single retrospective chart review of airway management published as an abstract recognised the challenges of intubation in the entrapped patient [119].…”