Basic life support trained nurses ventilate more efficiently with laryngeal mask supreme than with facemask or laryngeal tube suction-disposable--a prospective, randomized clinical trial.
OBJECTIVE
In some emergency situations resuscitation and ventilation may have to be performed by basic life support trained personnel, especially in rural areas where arrival of advanced life support teams can be delayed. The use of advanced airway devices such as endotracheal intubation has been deemphasized for basically-trained personnel, but it is unclear whether supraglottic airway devices are advisable over traditional mask-ventilation.


METHODS
In this prospective, randomized clinical single-centre trial we compared airway management and ventilation performed by nurses using facemask, laryngeal mask Supreme (LMA-S) and laryngeal tube suction-disposable (LTS-D). Basic life support trained nurses (n=20) received one-hour practical training with each device. ASA 1-2 patients scheduled for elective surgery were included (n=150). After induction of anaesthesia and neuromuscular block nurses had two 90-second attempts to manage the airway and ventilate the patient with volume-controlled ventilation.


RESULTS
Ventilation failed in 34% of patients with facemask, 2% with LMA-S and 22% with LTS-D (P<0.001). In patients who could be ventilated successfully mean tidal volume was 240±210 ml with facemask, 470±120 ml with LMA-S and 470±140 ml with LTS-D (P<0.001). Leak pressure was lower with LMA-S (23.3±10.8 cm H2O, 95% CI 20.2-26.4) than with LTS-D (28.9±13.9 cm·H2O, 95% CI 24.4-33.4; P=0.047).


CONCLUSIONS
After one hour of introductory training, nurses were able to use LMA-S more effectively than facemask and LTS-D. High ventilation failure rates with facemask and LTS-D may indicate that additional training is required to perform airway management adequately with these devices. High-level trials are needed to confirm these results in cardiac arrest patients.
Department of Anaesthesiology and Critical Care Medicine, Hospital of Bruneck, Spitalstrasse 11, 39031 Bruneck, Italy.
Elisabeth
E
Gruber
Department of Anaesthesiology and Critical Care Medicine, Hospital of Bruneck, Spitalstrasse 11, 39031 Bruneck, Italy. Electronic address: rosmarie.oberhammer@sb-bruneck.it.
Rosmarie
R
Oberhammer
EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bozen, Italy.
Karla
K
Balkenhol
EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bozen, Italy.
Giacomo
G
Strapazzon
EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bozen, Italy.
Emily
E
Procter
EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bozen, Italy.
Hermann
H
Brugger
Inova Q Inc., Tinkhauserstrasse 5, 39031 Bruneck, Italy.
Markus
M
Falk
Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
Peter
P
Paal
D000328:Adult; D000368:Aged; D003479:Curriculum; D004209:Disposable Equipment; D016529:Emergency Nursing / Q000193:education; D005260:Female; D006801:Humans; D017214:Laryngeal Masks; D008020:Life Support Care / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000451:nursing*; D013396:Suction; D013990:Tidal Volume
Airway management; Emergency medicine; Laryngeal mask; Laryngeal tube; Ventilation