title: Prehospital use in emergency patients of a laryngeal mask airway by ambulance paramedics is a safe and effective alternative for endotracheal intubation.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Research and Development, Regional Ambulance Service Hollands-Midden, Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Bosch
authors.affiliation: Medical Management, Regional Ambulance Service Hollands-Midden, Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: de Nooij
authors.affiliation: Research and Development, Regional Ambulance Service Hollands-Midden, Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: de Visser
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: S C
authors.initials: SC
authors.lastname: Cannegieter
authors.affiliation: Department of Epidemiology, Regional Public Health Organisation Hollands Midden, Leiden, The Netherlands.
authors.forename: N J
authors.initials: NJ
authors.lastname: Terpstra
authors.affiliation: Emergency Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Heringhaus
authors.affiliation: Centre for Human Drug Research, Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Burggraaf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D017214:Laryngeal Masks / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000628:therapy*; D055815:Young Adult
keywords: Trauma; airway; paramedics; resuscitation; ventilation, invasive