Emerg Med J doi:10.1136/emermed-2012-202283
  • Original article

Prehospital use in emergency patients of a laryngeal mask airway by ambulance paramedics is a safe and effective alternative for endotracheal intubation

Open Access
  1. J Burggraaf6
  1. 1Research and Development, Regional Ambulance Service Hollands-Midden, Leiden, The Netherlands
  2. 2Medical Management, Regional Ambulance Service Hollands-Midden, Leiden, The Netherlands
  3. 3Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
  4. 4Department of Epidemiology, Regional Public Health Organisation Hollands Midden, Leiden, The Netherlands
  5. 5Emergency Department, Leiden University Medical Center, Leiden, The Netherlands
  6. 6Centre for Human Drug Research, Leiden, The Netherlands
  1. Correspondence to J Bosch, Regional Ambulance Service Hollands Midden, Research and Development, PO Box 121, 2300 AC Leiden, The Netherlands; jbosch{at}
  • 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.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

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