Safety and feasibility of the laryngeal tube when used by EMTs during out-of-hospital cardiac arrest.
The American journal of emergency medicine · 2015-04-29 · Observational study
Abstract
BACKGROUND: Ventilation is still one key element of advanced life support. Emergency medical technicians (EMTs) without training in advanced airway management usually use bag valve mask ventilation (BVM). Bag valve mask ventilation requires proper training and yet may be difficult and ineffective. Supraglottic airway devices, such as the laryngeal tube (LT), have been proposed as alternatives. Safety and feasibility are unclear if used by EMTs with limited training only. We compared efficacy of the LT to BVM for out-of-hospital cardiac arrest in a primarily volunteer-based emergency medical services. METHODS: This is a prospective multicenter observational cohort study. We compared safety (injuries and regurgitation) and feasibility (successful ventilation) in patients who received BVM, LT, or fallback to BVM after LT and controlled for potential confounders using logistic regression. RESULTS: A total of 517 cases were documented, 395 (76.7%) with LT, 74 (14.4%) with BVM, and 48 (9.3%) where EMTs fell back from LT to BVM. There was no difference between groups regarding demographics (71 ± 17 years; 37% female) and initial rhythm (44% shockable). Placement of LT at first attempt was possible in 300 cases (76%), and at second attempt, in 91 cases (23%). Compared to BVM (22 cases [30%]), ventilation was more frequently successful with LT in 367 cases (93%; adjusted risk ratio, 3.1 [95% confidence interval, 1.3-7.1]; P < .01) and less successful with LT to BVM in 7 cases (15%; 0.3 [0.1-0.7]; P = .01). Five injuries (1.3%) were documented. Regurgitation was observed 8 (11%), 22 (6%; P < .01), and 8 times (17%; P < .01), respectively. CONCLUSIONS: Use of the LT during out-of-hospital cardiac arrest by EMTs with only basic training appears safe and feasible. Compared to BVM, success rates were higher. Injuries were relatively rare.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Bag-valve-mask ventilation · Paramedics & EMTs · Supraglottic airway
Related articles
- Use of Supraglottic Airway Devices by Paramedics in the Management of Adult Prehospital Cardiac Arrest Patients (Paramedicine, 2017)
- Effect of intermediate airway management on ventilation parameters in simulated paediatric out-of-hospital cardiac arrest: a multicentre randomised crossover trial. (Swiss Med Wkly, 2025)
- Continuous flow insufflation of oxygen compared with manual ventilation during out-of-hospital cardiac arrest: A survey of the paramedics. (SAGE Open Med, 2021)
- Outcomes With the Use of Bag-Valve-Mask Ventilation During Out-of-hospital Cardiac Arrest in the Pragmatic Airway Resuscitation Trial. (Acad Emerg Med, 2020)
- EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial. (Scand J Trauma Resusc Emerg Med, 2017)
- Comparison of different airway management strategies to ventilate apneic, nonpreoxygenated patients. (Crit Care Med, 2003)