title: Competence in the use of supraglottic airways by Australian surf lifesavers for cardiac arrest ventilation in a manikin.
abstract: OBJECTIVE
  Lifesavers in Australia are taught to use pocket mask (PM) rescue breathing and bag valve mask (BVM) ventilation, despite evidence that first responders might struggle with these devices. Novices have successfully used the Laryngeal Mask Airway (LMA) Supreme and iGel devices previously, but there has been no previous comparison of the ability to train lifesavers to use the supraglottic airways compared to standard techniques for cardiac arrest ventilation.
  
  
  METHODS
  The study is a prospective educational intervention whereby 113 lifesavers were trained to use the LMA and iGel supraglottic airways. Comparisons were made to standard devices on plastic manikins. Successful ventilation was defined as achieving visible chest rise.
  
  
  RESULTS
  The median time to first effective ventilation was similar between the PM (16 s, 95% confidence interval 16-17 s), BVM (17 s, 16-17 s) and iGel devices (18 s, 16-20 s), but longer for the LMA (36 s, 33-38 s). The iGel frequently failed to achieve ventilation (10%) compared with the PM (1%, P < 0.01) and LMA (3%, P < 0.01) but was not worse than the BVM (3%, P < 0.57). Hands-off time was similar between the BVM, LMA and iGel (10 s for each device), but worse for the PM (13 s, P = 0.001).
  
  
  CONCLUSIONS
  Lifesavers using the PM and BVM perform ventilation for cardiopulmonary resuscitation well. There appears to be a limited role for supraglottic airway devices because of limitations in terms of time to first effective ventilation and reliability. Clinical validation of manikin data with live resuscitation performance is required.
authors.affiliation: Life Saving Victoria, Melbourne, Victoria, Australia.|Ambulance Victoria, Melbourne, Victoria, Australia.
authors.forename: Lachlan
authors.initials: L
authors.lastname: Holbery-Morgan
authors.affiliation: Ambulance Victoria, Melbourne, Victoria, Australia.|School of Medicine, Deakin University, Melbourne, Victoria, Australia.
authors.forename: Cara
authors.initials: C
authors.lastname: Angel
authors.affiliation: Life Saving Victoria, Melbourne, Victoria, Australia.|Ambulance Victoria, Melbourne, Victoria, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Life Saving Victoria, Melbourne, Victoria, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Carew
authors.affiliation: Life Saving Victoria, Melbourne, Victoria, Australia.
authors.forename: Finn
authors.initials: F
authors.lastname: Douglas
authors.affiliation: Life Saving Victoria, Melbourne, Victoria, Australia.|Ambulance Victoria, Melbourne, Victoria, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Murphy
authors.affiliation: Surf Life Saving Australia, Sydney, New South Wales, Australia.|Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.
authors.forename: Natalie
authors.initials: N
authors.lastname: Hood
authors.affiliation: Life Saving Victoria, Melbourne, Victoria, Australia.|Department of Paediatrics, Albury Base Hospital, Albury, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rechtman
authors.affiliation: Life Saving Victoria, Melbourne, Victoria, Australia.|Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Scarff
authors.affiliation: Life Saving Victoria, Melbourne, Victoria, Australia.|Intensive Care Unit, University Hospital Geelong, Geelong, Victoria, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Simpson
authors.affiliation: Life Saving Victoria, Melbourne, Victoria, Australia.|Department of Infectious Diseases, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Stewardson
authors.affiliation: Life Saving Victoria, Melbourne, Victoria, Australia.|Department of Respiratory Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Steinfort
authors.affiliation: Life Saving Victoria, Melbourne, Victoria, Australia.|Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Sam
authors.initials: S
authors.lastname: Radford
authors.affiliation: Life Saving Victoria, Melbourne, Victoria, Australia.|Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Ned
authors.initials: N
authors.lastname: Douglas
authors.affiliation: Life Saving Victoria, Melbourne, Victoria, Australia.|Department of General Medicine, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Douglas
authors.initials: D
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D058109:Airway Management / Q000379:methods / Q000592:standards*; D001315:Australia; D004867:Equipment Design / Q000592:standards; D005260:Female; D005931:Glottis / Q000601:surgery*; D006323:Heart Arrest / Q000601:surgery; D006801:Humans; D008297:Male; D008348:Manikins; D008875:Middle Aged; D000066908:Simulation Training / Q000379:methods* / Q000592:standards; D013550:Swimming / Q000293:injuries; D013997:Time Factors
keywords: airway management; cardiac arrest; lifesaving; simulation; supraglottic airway