Original article

Emergency airway management by non-anaesthesia house officers—a comparison of three strategies

V Dörges¹, H Ocker¹, V Wenzel², C Sauer¹, P Schmucker¹

¹ Department of Anaesthesiology, Medical University of Lübeck, Lübeck, Germany
² Department of Anaesthesiology and Critical Care Medicine, The Leopold-Franzens- University of Innsbruck, Innsbruck, Austria

Correspondence to:
Correspondence to: Dr Dörges, Department of Anaesthesiology, Medical University of Lübeck, 23562 Lübeck, Ratzeburger Allee 160, Germany (v.doerges{at}t-online.de)

Objectives—The purpose of this study was to determine effects of different airway devices and tidal volumes on lung ventilation and gastric inflation in an unprotected airway.

Methods—Thirty one non-anaesthesia house officers volunteered for the study, and ventilated a bench model simulating an unintubated respiratory arrest patient with bag-valve-facemask, laryngeal mask airway, and combitube using paediatric and adult self inflating bags.

Results—The paediatric versus adult self inflating bag resulted with the laryngeal mask airway and combitube in significantly (p<0.001) lower mean (SEM) lung tidal volumes (376 (30) v 653 (47) ml, and 368 (28) v 727 (53) ml, respectively). Gastric inflation was zero with the combitube; and 0 (0) v 8 (3) ml with the laryngeal mask airway with low versus large tidal volumes. The paediatric versus adult self inflating bag with the bag-valve-facemask resulted in comparable lung tidal volumes (245 (19) v 271 (33) ml; p=NS); but significantly (p<0.001) lower gastric tidal volume (149 (11) v 272 (24) ml).

Conclusions—The paediatric self inflating bag may be an option to reduce the risk of gastric inflation when using the laryngeal mask airway, and especially, the bag-valve-facemask. Both the laryngeal mask airway and combitube proved to be valid alternatives for the bag-valve-facemask in this experimental model.

Keywords: bag-valve-mask; laryngeal mask airway; combitube; tidal volume; gastric regurgitation

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