title: Bag-mask ventilation and direct laryngoscopy versus intubating laryngeal mask airway: a manikin study of hands-on times during cardiopulmonary resuscitation.
abstract: OBJECTIVE
  The percentage of hands-on time during cardiopulmonary resuscitation is a major determinant of patient outcome. We hypothesized that airway management with the intubating laryngeal mask airway (ILMA) would give greater hands-on time than with bag-mask ventilation (BMV), followed by direct laryngoscopy (DL), particularly in difficult-to-manage airways.
  
  
  METHODS
  Thirty paramedics and 40 medical students performed four standardized, 6-min cardiopulmonary resuscitation scenarios with the SimMan3G in a random sequence. These were normal and difficult-to-manage airways using either BMV+DL or ILMA.
  
  
  RESULTS
  The time to the first successful ventilation was significantly longer with the ILMA (P<0.001). Hands-on time was lower for the ILMA after 2 min (67±8 vs. 81±8 s for BMV+DL, P<0.001), but was then significantly greater from the third minute onward (115±11 vs. 104±9 s for BMV+DL, P<0.001). The success rate of the first intubation attempt was higher and the time to ET placement was shorter with the ILMA, especially in the difficult-to-manage airway (P<0.001).
  
  
  CONCLUSIONS
  In this manikin-based study, hands-on time was greater with the ILMA than with BMV+DL. The ILMA was particularly useful in increasing hands-on times in the difficult-to-manage airway.
authors.affiliation: aDepartment of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Centre bDepartment of Medical Statistics, University of Göttingen, Göttingen cDepartment of Anaesthesiology, University of Regensburg, Regensburg, Germany.
authors.forename: Sebastian G
authors.initials: SG
authors.lastname: Russo
authors.forename: Christoph
authors.initials: C
authors.lastname: Stradtmann
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Crozier
authors.forename: Christiane
authors.initials: C
authors.lastname: Ringer
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Helms
authors.forename: Michael
authors.initials: M
authors.lastname: Quintel
authors.forename: Christoph H R
authors.initials: CH
authors.lastname: Wiese
mesh_terms: D058109:Airway Management / Q000379:methods; D000488:Allied Health Personnel / Q000706:statistics & numerical data; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D017214:Laryngeal Masks; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008348:Manikins; D012121:Respiration, Artificial; D013337:Students, Medical / Q000706:statistics & numerical data; D013997:Time Factors