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

Emerg Med J. 2014 Sep;31(9):750-3. doi: 10.1136/emermed-2012-202283. Epub 2013 Jun 15.

Abstract

Background: In 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.

Aim: To evaluate the effectiveness and suitability of the LMA-S for emergency medical services in daily out-of-hospital emergency practice.

Methods: After 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.

Results: The 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.

Conclusions: Ensuring ventilation support by using LMA-S by paramedics in prehospital emergency practice is safe and effective.

Keywords: Trauma; airway; paramedics; resuscitation; ventilation, invasive.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulances
  • Cardiopulmonary Resuscitation / methods
  • Emergency Medical Services*
  • Female
  • Humans
  • Laryngeal Masks* / standards
  • Laryngeal Masks* / statistics & numerical data
  • Male
  • Middle Aged
  • Netherlands
  • Prospective Studies
  • Respiratory Insufficiency / therapy*
  • Young Adult