The use of the laryngeal mask airway and Combitube® in cardiopulmonary resuscitation; a national survey
Introduction
The European Resuscitation Council has recommended the use of the laryngeal mask airway (LMA) and the Combitube during cardiopulmonary resuscitation (CPR). Indications for their use include the unconscious patient with absent glossopharyngeal and laryngeal reflexes at risk of airway obstruction who may need ventilation when intubation is precluded by lack of available expertise or equipment [1]. The LMA does not guarantee protection of the airway in every case but offers greater security than most other airways except the tracheal tube (TT) [2], [3], [4], [5]. Training is straightforward and manual ventilation is easier to perform than with a bag-valve-mask (BVM) for inexperienced personnel [4], [6], [7], [8], [9], [10]. The Combitube may offer comparable airway protection to the endotracheal tube but requires more expertise for insertion than the LMA and significant airway trauma has been reported [11], [12], [13].
Despite these recommendations, little is known as to how widely either the LMA or Combitube are used during CPR in the UK. We designed a questionnaire to assess this and to estimate how widespread use was likely to become.
Section snippets
Materials and methods
Two hundred and sixty-five Resuscitation Training Departments, from different hospitals throughout the UK, were identified from the Resuscitation Training Officer Directory (1999 Issue 1). Each was sent a postal questionnaire. A period of 4 months was allowed to elapse before the returned questionnaires were analysed at which point they were divided into four groups; group 1, LMA used currently; group 2, LMA not used currently but to be introduced in the future; group 3, LMA not used currently,
Results
One hundred and fifty-three questionnaires (58%) were returned within the 4-month period. The groups were comparable in terms of number of beds per hospital and number of cardiac arrests per year (Table 1).
Thirty-eight (25%) of the hospitals were using the LMA during CPR while 41 (27%) intended to use them in the future. Seventy-four (48%) had no intention of using the LMA and seven (5%) hospitals currently used the Combitube during CPR.
Anaesthetists were more commonly part of the cardiac
Discussion
Despite a response rate of 58%, our study illustrates the likely frequency of use of the LMA and Combitube during CPR throughout the UK.
Recommendations by the European Resuscitation Council for the use of the LMA and Combitube during CPR have been in place since 1996 while other publications have suggested advantages to their use since 1994 [14]. Despite these recommendations our study shows that only 25% of hospitals are using the LMA and 5% the Combitube, during CPR.
In those hospitals using
Portuguese Abstract and Keywords
A máscara ları́ngea (LMA) e o Combitube têm sido recomendados para utilização durante reanimação cardiopulmonar (CPR). Avaliou-se a prática corrente através de um inquérito postal a 265 departamentos de treino em reanimação, em diferentes hospitais de todo o Reino Unido. Foram devolvidos 153 (58%) questionários preenchidos. Apenas 38 (25%) hospitais que responderam usavam na altura a LMA em reanimação, enquanto 7 (5%) usavam o Combitube. As razões para não
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Cited by (0)
Portuguese Abstract and Keywords
A máscara ları́ngea (LMA) e o Combitube têm sido recomendados para utilização durante reanimação cardiopulmonar (CPR). Avaliou-se a prática corrente através de um inquérito postal a 265 departamentos de treino em reanimação, em diferentes hospitais de todo o Reino Unido. Foram devolvidos 153 (58%) questionários preenchidos. Apenas 38 (25%) hospitais que responderam usavam na altura a LMA em reanimação, enquanto 7 (5%) usavam o Combitube. As razões para não utilizarem estes adjuvantes da via aérea incluı́am: a preocupação com a protecção da via aérea, dificuldade no treino, custo e a noção de que quando a equipa de reanimação inclui a presença de anestesistas estes utensı́lios são desnecessários.
Palavras chave: Ressuscitação cárdiopulmonar (CPR); Máscara ları́ngea (LMA); Combitube
Spanish Abstract and Keywords
La máscara ları́ngea (LMA) y el Combitube han sido recomendados para ser usados durante la reanimación cardiopulmonar (CPR). Para buscar una visión completa de la práctica real, se realizó una encuesta postal a 265 departamentos de entrenamiento en resucitación, en diferentes hospitales en el Reino Unido. Fueron devueltos ciento cincuenta y tres cuestionarios completos (58%). Solo 38 (25%) de los hospitales que respondieron estaban usando LMA en resucitación, mientras que 7 (5%) estaban usando el Combitube. Las razones para no usar estos accesorios para vı́a aérea incluyeron preocupación por la protección de la vı́a aérea, dificultades en el entrenamiento, costo, y el concepto de que estos equipos eran innecesarios cuando habı́an anestesistas disponibles en los equipos de paro cardı́aco.
Palabras clave: Resucitación cardiopulmonar RCP (CPR); Máscara Ları́ngea (LMA); Combitube