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In 2001 the Warwickshire Ambulance Service introduced disposable laryngeal mask airways (LMA Unique, Intavent Orthofix, Maidenhead, UK) aiming to improve airway care by providing paramedics with an alternative device after failed intubation, and giving technicians an alternative to the bag-valve-mask.1 In April 2003 we analysed the computerised record database and surveyed all paramedics and technicians to investigate LMA use over the previous two years.
We searched the database for details about patients who had a LMA inserted during their care. The individual case report forms for these patients were reviewed when available. In 70 patients LMA placement was attempted, 61 (87%) placements had been recorded as successful. LMA insertion was recorded as successful in 24 of 25 (96%) patients when a technician attempted placement and 37 of 45 (82%) patients when a paramedic attempted placement. Intubation had failed in 29 patients and in 26 (89%) of these a LMA was successfully used to manage the airway (table 1). During this period there were 382 attempts at endotracheal intubation with 85% success. Although primarily used in cardiac arrest (49 cases), LMAs were also used in “other medical” patients (seven cases) and trauma (six cases), with eight missing records. In three road trauma cases a LMA provided a clear airway when access was otherwise impossible. On nine occasions a functioning LMA was subsequently replaced by an endotracheal tube before arrival at hospital. In seven of these instances no clear reason was recorded.
A total of 134 staff surveys were returned (85% response). These questionnaires showed that 42 (36%) had never used an LMA in clinical practice, 52 (39%) had used a LMA once or twice, 34 (25%) staff had used the LMA three to five times, and six (4%) had used the device on more than six occasions.
We asked whether any patients who had received a LMA had been subsequently intubated before arrival at hospital. Of the 40 positive answers, 25 responses stated that the LMA was removed because of “operator preference” (23 paramedic, 2 doctor). The other responses to this question included six problems with ventilation and eight problems with securing the device.
The success rates are similar to those reported in the literature.2,3 The LMA has been used in a range of conditions, but is clearly unrivalled in situations where intubation has failed or is impossible.4 We are concerned that functioning LMAs are being removed in favour of endotracheal intubation, as there is little evidence showing that intubation improves outcome,5,6 especially in those sufficiently comatose not to require the use of drugs to facilitate this procedure. We feel that the introduction of LMAs in Warwickshire has achieved the aims that were intended.
KP, IT, JT, and MW conceived the idea for the study. MW, IT, and JT designed the questionnaire. KP and JT collected the data. KP wrote the paper. The paper was discussed, revised, and edited by KP, IT, JT and MW. MW is the guarantor of the paper.
This work was presented in part at the Basics conference, November 2003
Funding: none declared.
Competing interests: none declared.