title: Intubating laryngeal mask airway placement by non-physician healthcare providers in management out-of-hospital cardiac arrests: a case series.
abstract: OBJECTIVE
  The role of supralaryngeal devices in airway management in out-of-hospital cardiac arrests (OHCA) remains controversial. The aim of this prospective observational trial was to evaluate the feasibility and effectiveness of intubating laryngeal mask airway (ILMA) when used by trained prehospital emergency nurses in the setting of OHCA.
  
  
  METHODS
  After approval from the Research Ethics Board, prehospital emergency nurses trained in placement of ILMA (Fastrach™, LMA Vitaid, Toronto, Ontario, Canada) followed a formal protocol for airway control during OHCA. The primary outcome was the success rate of ILMA placement, while secondary outcomes were success rate of tracheal intubation through the ILMA, and the incidence of regurgitation of gastric contents.
  
  
  RESULTS
  During the study period, 302 ILMA placements were attempted by emergency nurses during OHCA resuscitation. After ILMA placement, but before attempt for intubation, ventilation was possible in 290 patients (96%). Obstruction or major leaks were observed in 12 patients (4%). Tracheal tube insertion through the ILMA was attempted in 265 patients, and was performed in 254 (95.8%). This allowed for proper lung ventilation through the tracheal tube in 242 cases whereas 12 tubes were esophageal or proved obstructed. Regurgitation of gastric contents occurred in 43 (14.2%) patients; in 23 cases before arrival of the first aid team, in 18 cases before ILMA placement, and in 2 cases after the ILMA placement.
  
  
  CONCLUSIONS
  The use of ILMA for airway management by trained emergency nurses during OHCA resuscitation is feasible and allows for effective airway management. The success rate of tracheal tube placement through the ILMA was high. In addition, the incidence of regurgitation was lower when using the ILMA than that previous historical reports with face-mask ventilation.
authors.affiliation: Department of Anaesthesiology, Critical Care and Prehospital Emergency Medicine, Hôpitaux Universitaires de Strasbourg, University of Strasbourg, BP 426, 67098 Strasbourg, France; Fire and Rescue Department Bas-Rhin, 2 Route de Paris, 67087 Strasbourg Cedex 2, France. Electronic address: laurent.tritsch@chru-strasbourg.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Tritsch
authors.affiliation: Department of Anaesthesiology & University of Ottawa Skills and Simulation Centre (uOSSC), The Ottawa Hospital, The Academy for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, 501 Smyth Road, Ottawa K1H 8L6, Ontario, Canada.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Boet
authors.affiliation: Department of Anaesthesiology, Critical Care and Prehospital Emergency Medicine, Hôpitaux Universitaires de Strasbourg, University of Strasbourg, BP 426, 67098 Strasbourg, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Pottecher
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Girish P
authors.initials: GP
authors.lastname: Joshi
authors.affiliation: Department of Anaesthesiology, Critical Care and Prehospital Emergency Medicine, Hôpitaux Universitaires de Strasbourg, University of Strasbourg, BP 426, 67098 Strasbourg, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Diemunsch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006282:Health Personnel; D006801:Humans; D007442:Intubation, Intratracheal / Q000592:standards; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies
keywords: Airway; Regurgitation; Resuscitation