Teleflex | LMA - Better by Design

Authors

Publication

Resuscitation 2014; 85 (4): 499–502.

Summary

• A study to compare aspects of airway management and ventilation with the LMA Supreme™, the laryngeal tube suction-disposable and facemask ventilation when placed by nurses who had received only minimal training in their use
• After minimal training, nurses with basic life support skills were able to use the LMA Supreme™ more effectively to ventilate patients than either the laryngeal tube suction-disposable or facemask ventilation

Objectives:

• To compare aspects of airway management and ventilation with the LMA Supreme™, the laryngeal tube suctiondisposable and facemask ventilation when placed by nurses who had received only minimal training in their use

Method:

• This was a prospective study conducted in American Society of Anesthesiologists class 1-2 patients undergoing elective surgery
• Patients were randomised to receive the LMA Supreme™, the laryngeal tube suction-disposable or facemask ventilation for airway management
• Twenty nurses who had undergone basic life support training but who had no clinical experience of airway management were selected to place the devices
  • Placement of the devices was done in the operating theatre under the supervision of anaesthesiologists
  • The devices were placed within three months of the nurses undergoing a 1-hour practical training session on their use
  • Nurses were allowed a maximum of two 90-second attempts to manage the airway and to ventilate the patient
• Outcomes of interest were
  • Time to effective ventilation
  • Tidal volume
  • Peak airway pressure
  • Leak pressure

Results:

• Male and female patients were randomised to receive airway management with the LMA Supreme™ (n=50), the laryngeal tube suction-disposable (n=50) or facemask ventilation (n=50)
  • The demographic and baseline characteristics (including haemodynamic and pulmonary parameters) of patients in the three treatment groups were similar
  • The mean age and body mass index of patients was 47.7-49.4 years and 23.7-24.6 kg/m², respectively
• Successful airway management was more often achieved in patients who had the LMA Supreme™ inserted (Figure 1)

Figure 1. Rate of ventilation failure* with the LMA Supreme™, laryngeal tube suction-disposable and facemask ventilation when placed by nurses with minimal training in their use

• Aspects of ventilation with the three devices are shown in Table 1

Table 1. Aspects of ventilation with the LMA Supreme™, laryngeal tube suction-disposable and facemask ventilation when placed by nurses with minimal training in their use†

† Data (shown only for those patients in whom ventilation was successful) are presented as mean ± standard deviation
‡ Time from first contact with the device to correct airway management and obvious chest expansion during manual ventilation
* p<0.001 for the between-group difference; ** p<0.05 vs. laryngeal tube suction-disposable

• Rates of stomach insufflation were comparable in the three treatment groups
• Blood stains were less often observed on the LMA Supreme™ than on the laryngeal tube suction-disposable (21% vs. 49%; p<0.05)

Conclusions:

• After minimal training, nurses with basic life support skills were able to use the LMA Supreme™ with a high rate of success in a non-emergency situation
• Nurses were able to use the LMA Supreme™ more effectively to ventilate patients than either the laryngeal tube suctiondisposable or facemask ventilation