EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial

Anna Fiala,Michael Baubin,Wolfgang Lederer,Peter Paal,Agnes Neumayr,Ernst Toferer,Sabrina Neururer,Tamara Egger

doi:10.1186/s13049-017-0446-1

Abstract

BackgroundLaryngeal tube (LT) application by rescue personnel as an alternate airway during the early stages of out-of-hospital cardiac arrest (OHCA) is still subject of debate. We evaluated ease of handling and efficacy of ventilation administered by emergency medical technicians (EMTs) using LT and bag-valve-mask (BVM) during cardiopulmonary resuscitation of patients with OHCA.MethodsAn open prospective randomized multicenter study was conducted at six emergency medical services centers over 18 months. Patients in OHCA initially resuscitated by EMTs were enrolled. Ease of handling (LT insertion, tight seal) and efficacy of ventilation (chest rises visibly, no air leak) with LT and BVM were subjectively assessed by EMTs during pre-study training and by the attending emergency physician on the scene. Outcome and frequency of complications were compared.ResultsOf 97 eligible patients, 78 were enrolled. During pre-study training EMTs rated efficacy of ventilation with LT higher than with BVM (66.7% vs. 36.2%, p = 0.022), but efficacy of on-site ventilation did not differ between the two groups (71.4% vs. 58.5%, p = 0.686). Frequency of complications (11.4% vs. 19.5%, p = 0.961) did not differ between the two groups.ConclusionsEMTs preferred LT ventilation to BVM ventilation during pre-study training, but on-site there was no difference with regard to efficacy, ventilation safety, or outcome. The results indicate that LT ventilation by EMTs during OHCA is not superior to BVM and cannot substitute for BVM training. We assume that the main benefit of the LT is the provision of an alternative airway when BVM ventilation fails. Training in BVM ventilation remains paramount in EMT apprenticeship and cannot be substituted by LT ventilation.Trial registrationClinicalTrials.gov (NCT01718795).

Highlights

Laryngeal tube (LT) application by rescue personnel as an alternate airway during the early stages of out-of-hospital cardiac arrest (OHCA) is still subject of debate
According to the Emergency medical technicians (EMT)’ subjective assessment, ease of handling correlated with efficiency of ventilation when using the LT (p = 0.037)
EMTs preferred LT ventilation to BVM ventilation during pre-study training, but on site no difference was seen in efficacy, ventilation safety or outcome

Summary

Introduction

Laryngeal tube (LT) application by rescue personnel as an alternate airway during the early stages of out-of-hospital cardiac arrest (OHCA) is still subject of debate. We evaluated ease of handling and efficacy of ventilation administered by emergency medical technicians (EMTs) using LT and bag-valve-mask (BVM) during cardiopulmonary resuscitation of patients with OHCA. Supraglottic airways including the laryngeal tube (LT) enable rapid and effective ventilation in most cases [1]. Conventional bag-valve-mask (BVM) ventilation and endotracheal intubation may be difficult, especially when caregivers have little experience. The promoted simplicity in handling makes the LT an attractive device for airway management during cardiopulmonary resuscitation (CPR), even for healthcare providers with only basic training [2]. Kurola et al observed that the LT may enable rapid and effective airway control as compared to BVM when used by inexperienced personnel [6]. Ventilation by LT may be advantageous when anatomic conditions, e.g. facial hair, edentulism, facial dysmorphia and obesity, make BVM ventilation difficult or even impossible

Objectives

Methods

Results

Discussion

Conclusion