Airway management in cardiac arrest—comparison of the laryngeal tube, tracheal intubation and bag-valve mask ventilation in emergency medical training
Introduction
Successful management of the patient in cardiac arrest includes adequate oxygenation and ventilation. Health care professionals are instructed to use bag-valve mask (BVM) ventilation, and the “gold standard” of securing the airway is considered to be tracheal intubation (ETI) [1]. Because the BVM and ETI require special skills, and both methods have been shown to be difficult even for health care professionals [2], [3], alternative devices for airway management have been investigated. One of these is the laryngeal tube (LT, VBM Medizinteknik Sulz a.N-Germany GmbH), a new device which is inserted blindly into the oropharynx of the patient [4]. It has been tested successfully and used in simulated cardiac arrest in manikins and anaesthesia [5], [6]. We wanted to evaluate the value of the LT as the initial method of establishing an open airway and starting ventilation in a simulated cardiac arrest situation. The aim of the study was to compare the speed of initiation and the effectiveness of ventilation using the LT, ETI and BMV as part of the basic training of fire-fighter students.
Section snippets
Methods
The section on airway management in the curriculum for airway management for fire-fighter emergency medical technicians (EMTs) at the national Emergency Services College in Kuopio, Finland, consists of 20 h didactic lessons and simulations. It includes application of the BVM using a one-person technique to assist ventilation, and ETI to secure the airway in a cardiac arrest situation. In a cardiac arrest call attended by two rescuers, one EMT clears the airway while the other one performs
Results
On the day of the test, two students reported ill, leaving 29 pairs to complete the test. All teams carried out the test according to the protocol. Initial evaluation of the patient was equally fast among all teams, and the first defibrillatory shock was delivered in less than 61 s from the beginning of the test in all groups (Fig. 1). Nineteen teams were allocated to insert the LT, 19 teams to perform ETI and 20 teams to use BVM ventilation. All teams successfully inserted the LT or performed
Discussion
In this test situation, clinically inexperienced EMT students successfully inserted the LT or performed ETI in a manikin. Compared with BVM, minute ventilation was significantly higher with both the LT and ETI. The results confirm those presented in a recent study, describing experienced clinicians evaluating ventilation with the same devices in simulated CPR [7]. In the present study, which also focused on timing in the management of the “patient”, the speed of initiation of ventilation was
Conclusions
In a simulated cardiac arrest situation, clinically inexperienced EMT students successfully inserted the LT or performed ETI. Initiation of ventilation was faster with the LT than with ETI. Compared with BVM, the LT provided better minute ventilation during CPR. The value of the LT as the initial device to manage the airway in cardiac arrest requires assessment in clinical trials.
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