Elsevier

Resuscitation

Volume 38, Issue 1, July 1998, Pages 3-6
Resuscitation

The incidence of regurgitation during cardiopulmonary resuscitation: a comparison between the bag valve mask and laryngeal mask airway

https://doi.org/10.1016/S0300-9572(98)00068-9Get rights and content

Abstract

The risk of gastric regurgitation and subsequent pulmonary aspiration is a recognised complication of cardiac arrest—a risk which may be further increased by the resuscitative procedure itself. The purpose of this study was to compare the incidence of gastric regurgitation between the bag valve mask (BVM) and laryngeal mask airway (LMA). The resuscitation data collection forms of 996 patients who underwent in-hospital cardiopulmonary resuscitation over a 3.5 year period were reviewed. Of these, 199 patients were excluded from the study because there was no airway management involving a BVM or LMA. The incidence and timing of regurgitation was studied in the remaining 797 patients. Regurgitation was recorded to have occurred at some stage in 180 of these patients (22.6%). However, 84 regurgitated prior to CPR (46.7% of those patients who regurgitated). These patients were excluded from further analysis as regurgitation could not have been affected by any form of ventilation. Of the remaining 713 patients, BVM ventilation was used in 636 cases. In 170 of these the LMA was also used following the BVM. Where the patient was ventilated with the BVM alone or BVM followed by ETT the incidence of regurgitation during CPR was 12.4%. The LMA was used during resuscitation in 256 cases of which 170 had BVM ventilation prior to the LMA. Where the patient was ventilated with the LMA alone or LMA followed by ETT the incidence of regurgitation during CPR was 3.5%. The study confirms experience reported in earlier studies that when an LMA is used as a first line airway device, regurgitation is relatively uncommon.

Introduction

Gastric regurgitation remains an acknowledged complication of cardiac arrest [1]. The risk is further increased during the resuscitation process by pressure changes generated during external chest compressions and positive pressure ventilation through an unprotected airway. In addition to this, cardiac arrest may well occur in patients with full stomachs. Normal protection from gastric regurgitation and consequent pulmonary aspiration is abolished by relaxation of the lower oesophageal sphincter and obtundation of the protective laryngeal reflexes.

During cardiac arrest initial ventilation is commonly performed using a self inflating bag valve mask (BVM), prior to the insertion of another device designed to provide definitive airway security [2]. The conventional definitive airway is recognised to be the cuffed tracheal tube (ETT), but placement requires a considerable period of training and regular practice to achieve competence. To provide training and practice for all health care professionals who might attend a patient suffering cardiac arrest is probably an unattainable goal. For this reason alternative airways, such as the laryngeal mask airway (LMA) and the combitube, which require less training for their use, have been studied to assess their effectiveness in comparison with BVM ventilation 3, 4.

The aim of this study was to assess the comparative incidence of gastric regurgitation associated with the BVM and LMA.

Section snippets

Type of hospital

The Conquest Hospital, Hastings is a 490 bed district general hospital on the South Coast of England. The hospital, which was opened in 1992, serves a population of 168 000 with a significant proportion of elderly residents. All of the acute services are situated on one site facilitating immediate response to cardiac arrests.

Resuscitation services

The hospital has employed a full-time resuscitation training officer (RTO) since 1985. Every ward and department is equipped with a standard cardiac arrest trolley and

Overall incidence and timing of regurgitation

Regurgitation was recorded to have occurred at some stage in 180 of the patients studied (22.6%). The timing of regurgitation is shown in Table 1. Those patients who regurgitated prior to CPR (n=84) were excluded from further analysis as regurgitation could not have been affected by any form of ventilation. Analysis of the remaining 713 patients was split between those patients ventilated with the BVM, those ventilated with the LMA and those ventilated with both devices. The incidence and

Discussion

Our results confirm that gastric regurgitation is a common complication of cardiopulmonary arrest. In this series which excluded patients who responded very quickly to CPR/defibrillation and patients ventilated without the use of a BVM or LMA, some 22.6% (180/797) had recorded evidence of gastric regurgitation. However, 46.7% (84/180) of these were known to have regurgitated before any form of airway management was attempted and it is difficult to suggest any measure to prevent this occurring.

Conclusion

Our results show that, for patients suffering cardiac arrest, there is a high incidence of regurgitation occurring prior to cardiopulmonary resuscitation and during resuscitation with an unprotected airway and BVM. When the LMA is used as the first line airway device, regurgitation during CPR was found to be significantly less likely than when the BVM was used as the first line airway device. This confirms experience reported in earlier studies 3, 7, 8, 9, 10.

Acknowledgements

We thank D. Ruffer for her help in collection of the cardiac arrest data.

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