Prehospital use in emergency patients of a laryngeal mask airway by ambulance paramedics is a safe and effective alternative for endotracheal intubation
- 1Research and Development, Regional Ambulance Service Hollands-Midden, Leiden, The Netherlands
- 2Medical Management, Regional Ambulance Service Hollands-Midden, Leiden, The Netherlands
- 3Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- 4Department of Epidemiology, Regional Public Health Organisation Hollands Midden, Leiden, The Netherlands
- 5Emergency Department, Leiden University Medical Center, Leiden, The Netherlands
- 6Centre for Human Drug Research, Leiden, The Netherlands
- Correspondence to J Bosch, Regional Ambulance Service Hollands Midden, Research and Development, PO Box 121, 2300 AC Leiden, The Netherlands;
- Received 14 December 2012
- Revised 28 March 2013
- Accepted 12 May 2013
- Published Online First 15 June 2013
Background In Dutch ambulance practice, failure or inability to intubate patients with altered oxygenation and/or ventilation leaves bag-valve mask ventilation as the only alternative, which is undesirable for patient outcome. A novel Laryngeal Mask Airway Supreme (LMA-S) device may be a suitable alternative.
Aim To evaluate the effectiveness and suitability of the LMA-S for emergency medical services in daily out-of-hospital emergency practice.
Methods After a period of theoretical and practical training of ambulance paramedics in the use of the LMA-S, prospective data were collected on the utilisation of LMA-S in an observational study. Procedures for use were standardised and the evaluation included the number of direct intubation attempts before using LMA-S, attempts required, failure rate and the adequacy of ventilation. Data were analysed taking patient characteristics such as age and indication for ventilatory support into account.
Results The LMA-S was used 50 times over a period of 9 months (33 involving cardiorespiratory arrest, 14 primary and three rescue). The LMA-S could be applied successfully in all 50 cases (100%) and was successful in the first attempt in 49 patients (98%). Respiratory parameters showed adequate oxygenation. All paramedics were unanimously positive about the utilisation of LMA-S because of the easiness of the effort of insertion and general use, and emphasised its value as a useful resource for patients in need.
Conclusions Ensuring ventilation support by using LMA-S by paramedics in prehospital emergency practice is safe and effective.
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