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• Basic Life Support should be kept basic.
  Andrew M. Mason
  Published on: 29 April 2016

• Published on: 29 April 2016

  Basic Life Support should be kept basic.

  • Andrew M. Mason, Immediate Care physician

  Although the definition of Basic Life Support (BLS) does vary between sources, it is probably best regarded as, "a level of medical care that can be used to treat patients with life-threatening illness or injury without the use of any advanced or invasive medical procedures or intravenous access". It should be possible for any rescuer in any situation to render BLS simply by using hands and lungs, although simple improvi...

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  Although the definition of Basic Life Support (BLS) does vary between sources, it is probably best regarded as, "a level of medical care that can be used to treat patients with life-threatening illness or injury without the use of any advanced or invasive medical procedures or intravenous access". It should be possible for any rescuer in any situation to render BLS simply by using hands and lungs, although simple improvised items (such as a handkerchief plus necktie or tights to apply local pressure to a bleeding wound) should also be allowed. Some would extend the list of permitted adjuncts to include a face shield/pocket mask or even an oropharyngeal airway. However, to stretch the concept of BLS to include the use of a bag-valve-mask device (BVMD), laryngeal mask airway (LMA) or laryngeal tube (LT) probably strays too far into the realms of advanced life support. If this is the case, then the title of the paper by Dixon et al.[1] was inaccurately worded.

  In reality, the BVMD is probably one of the trickiest items to use correctly in prehospital care, and some would say its use requires two persons – one to hold the mask securely against the patient’s face and the other to squeeze the bag. Certainly, to ventilate the lungs correctly with a BVMD without inflating the stomach requires considerable skill.

  The authors failed to state which versions of the selected supraglottic airway devices (SADs) were used in the trial. The Laryngeal Tube is available with both a single lumen (LT & LT-D) and dual lumens (LTSII & LTS-D), the dual-lumen versions featuring a gastric drainage channel in addition to the airway tube. With its distal balloon inflated within the manikin’s upper oesophagus, it is hardly surprising that the authors found a low incidence of gastric insufflation with the LT, particularly if the device also featured a gastric drainage channel opening beyond the distal balloon. Also, the authors failed to state which type of LMA was used by way of comparison. If this was a basic LMA (e.g., the LMA Classic, LMA Unique, Ambu LM or Softseal LM) then a direct comparison with any LT device was probably unfair with respect to the rates of gastric insufflation. It would have been better to have compared the LT with either the LMA Proseal or the disposable LMA Supreme or i-Gel airways - all of which have gastric drainage channels like the LT-D. It should also be noted that the correct sizing of a supraglottic airway device is particularly important when attempting to ventilate manikins, and the same size of airway does not always provide the optimum fit with a particular manikin across the entire range of SADs from different manufacturers. An ill-fitting basic LMA will never be a match for a correctly-sized LT on any of its performance characteristics.

  Bearing in mind all these points, the authors’ conclusions need to be viewed with a degree of caution.

  REFERENCE: 1. Dixon M, Carmody N, O’Donnell C. The effectiveness of supraglottic airway devices in prehospital Basic Life Support airway management. Emerg Med J 2009; 26: 4.

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  Conflict of Interest:
  None declared.

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