Airway management during cardiopulmonary resuscitation—a comparative study of bag–valve–mask, laryngeal mask airway and combitube in a bench model
Introduction
Tracheal intubation is the gold-standard of airway management during cardiopulmonary resuscitation (CPR). However, intubation skills require an extensive period of training and continuous practice. Accordingly, it has been recommended to perform bag–valve–mask ventilation in an unintubated cardiac arrest patient until rescuers arrive who are capable of performing advanced cardiac life support. Although other airway devices such as the laryngeal mask airway [1], [2] and the combitube [3] have been suggested as alternatives for the basic life support phase management of the airway, it is unclear whether healthcare professionals who have no formal training in using these devices can use them adequately.
Performing bag–valve–mask ventilation may be difficult, especially for healthcare workers with infrequent experience in difficult conditions such as cardiac arrest. For example, recent observations of the lower esophageal sphincter pressure during cardiac arrest indicate that respiratory mechanics may be significantly altered rendering gastric inflation during bag–valve–mask ventilation very likely. As such, both pulmonary hypoventilation and gastric inflation induced during the basic life support phase may adversely affect patient outcome. Also, compliance of the respiratory system during CPR may change significantly [4], [5]. Using an alternative airway device such as the laryngeal mask airway or the combitube may improve ventilation, and decrease ventilation-associated complications such as gastric inflation.
However, it is unknown whether nursing staff who have been minimally trained in basic life support airway management may be able to adequately employ these alternative airway devices.
Accordingly, the purpose of the study was to assess lung ventilation and gastric inflation when performing ventilation with bag–valve–mask, laryngeal mask airway, and combitube in a bench model simulating an unintubated cardiac arrest patient.
Section snippets
Experimental model
Pilot experiments revealed that conventional CPR mannequin heads may not serve as an adequate bench model for evaluation of the combitube and laryngeal mask airway. For example, it is almost impossible to achieve a sufficient seal of the oropharynx with the oropharyngeal cuff of the combitube, or to accurately locate the laryngeal mask airway. We used a recently developed mannequin head (VBM Medizintechnik, Sulz, Germany) with a smaller diameter of the oropharynx, which enables realistic
Results
Twenty-one training nurses (17 female, 4 male; age 21–43) performed ventilation on our bench model with bag–valve–mask, laryngeal mask airway, and combitube, respectively. Four participants exceeded the time limit for the first adequate ventilation (180 s, lung volume >200 ml) in the bag–valve–mask group, two in the combitube group, and no one in the laryngeal mask airway group. Within 3 min, the success rate for the first adequate ventilation was 100% for the laryngeal mask airway, 90% for the
Discussion
Tracheal intubation is the gold standard to secure the airway during CPR. However, performing tracheal intubation requires excellent skills and experience, and therefore, is usually performed by professional rescuers. Hence, particularly during basic life support management of a cardiac arrest victim, the standard recommendation for ventilation has been to use the bag–valve–mask while waiting for a professional rescuer who is capable of advanced airway management such as tracheal intubation [6].
Acknowledgements
The authors would like to thank our nursing school and the student nurses for participating in our study. We also gratefully acknowledge the support of Thomas Meyer.
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2014, American Journal of Emergency MedicineCitation Excerpt :The 2 LMAs have been compared again but in a completely different setting [18], with results that are in line with ours. CLMA is the commonest SAD used in resuscitation and its use in CPR has been the subject of a number of publications [6-14]. It is argued that CLMA is easier and faster to use in resuscitation compared to ETI [10,11] and safer than bag-mask ventilation [12-14].
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2012, ResuscitationCitation Excerpt :However, few reports have directly evaluated OHCA outcomes after airway management with the LMA. The LMA is widely accepted in the operating room and has been recommended as an alternative airway for use by basic-level rescuers.7–9 Few report have investigated the association between airway management and OHCA outcomes in an EMS system where CPR should give during ambulance transport to destination ED.