Comments on the Laryngeal Mask Insertion Technique Presented in the New Advanced Cardiac Life Support Protocol

Abstract

To the Editor: The new 2000 guidelines for cardiopulmonary resuscitation and emergency cardiovascular care were published in August 2000.1 The laryngeal mask airway (LMA) was presented as an alternative airway. We would like to comment on the illustration to insert the LMA. The picture depicts several classic mistakes made during the insertion of the LMA. These may lead to LMA malpositioning and inability to achieve an airway and ventilation.2 In the 2000 guidelines, the LMA is depicted with a semi-inflated cuff, held by the shaft with the left hand and introduced straight into the mouth. The correct LMA technique3 is based on a close imitation of the swallowing mechanism. Before attempting insertion, the LMA cuff should be completely deflated and lubricated. The LMA is held with the dominant hand. The hand holds the LMA like a pen, with the index finger placed at the junction of the cuff and the shaft, with the LMA opening oriented over the tongue. The LMA is passed behind …