Feasibility of Laryngeal Mask Airway Use by Prehospital Personnel in Simulated Pediatric Respiratory Arrest

Abstract

Introduction. Pediatric respiratory arrest is a technically challenging scenario infrequently faced by prehospital providers. Prehospital endotracheal intubation (ETI) is a complex procedure, andone study showed that it may result in worse neurological outcome in these patients. Alternatives to ETI include bag-valve-mask (BVM) ventilation andthe laryngeal mask airway (LMA). Although the LMA has been used successfully for pediatric resuscitation in the hospital setting, there is no data describing its use in the prehospital setting. Hypothesis. Prehospital providers can successfully place andventilate the pediatric LMA in a simulated pediatric respiratory arrest. Methods. Paramedic students received a 1-hour training session covering the use of the pediatric LMA. Subjects performed airway management of a simulator manikin using both the LMA andthe BVM. Rate of successful LMA placement, time to first ventilation, tidal volume by weight, andventilations per minute were recorded. A generalized estimating equation analysis was completed to determine the effects of time andventilation technique. Results. All 13 subjects (100%) successfully ventilated the mannequin with both techniques. The median number of attempts required to successfully place the LMA was one. Median time from the start of the scenario to BVM ventilation was 4 seconds (IQR 3, 5), andthe median for LMA ventilation was 30 seconds (IQR 25, 52). Tidal volumes were significantly greater with BVM ventilation (5.07 mL/kg [IQR 4.47, 5.43]) than with LMA ventilation (2.88 mL/kg [IQR 2.17, 4.04]). An obvious air leak was present in all LMA cases, potentially resulting in reduced tidal volume delivery. Excessive ventilatory rates were noted in both BVM (42 ventilations per minute [IQR 33, 46]) andLMA (37 ventilations per minute [IQR 31, 39]) groups. Conclusions. Prehospital providers were able to place andventilate a simulated pediatric respiratory arrest patient using the LMA after a brief educational intervention. Obvious air leakage was noted when ventilating with the LMA andlikely represents one technical limitation of using a simulator.