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Effective ventilation during CPR via an LMA Supreme™

Authors

Murdoch H., Cook T.M.

Publication

Anaesthesia 2008; 63 (3): 326.

Summary

  • A case of effective ventilation using the LMA Supreme™ during cardiopulmonary resuscitation was reported

Case report:

  • A case of effective ventilation using the LMA Supreme™ during cardiopulmonary resuscitation was reported
  • The incident occurred in a 75 kg patient about to undergo axillary clearance  
    • The patient was American Society of Anesthesiologists physical status 2 and was enrolled in a study to evaluate the performance of the LMA Supreme™
  • After anaesthesia was induced without incident the LMA Supreme™ was successfully inserted and controlled ventilation was initiated
    • A square wave capnogram, normocapnia and 100% oxygen saturation were achieved
  • A blood pressure reading of 70/34 mmHg was recorded 15 minutes after anaesthesia was induced (but before surgery had commenced)
    • A second reading was not recordable
  • Further investigations indicated an apparent ECG arrhythmia consistent with ventricular fibrillation and a lack of a palpable pulse
  • Chest compressions were initiated and were continued for one minute while ventilation via the LMA Supreme™ with 100% oxygen was continued
  • Subsequent assessments showed that the capnogram was of a normal shape and was associated with a normal end-tidal carbon dioxide level
    • No signs of poor perfusion, including cyanosis, were evident
  • Chest compressions were ceased and a normal sinus rhythm (at a rate of 55 beats per minute) was evident on the ECG
  • Following the administration of metaraminol 1 mg, a blood pressure reading of 75/40 mmHg was recorded, with subsequent improvement thereafter
  • A peripheral pulse was evident and a 12-lead ECG indicated sinus bradycardia (50 beats per minute) in the absence of any new changes
  • It was decided that surgery should continue, and no other complications occurred
  • The apparent cause of the event was the combination of (i) a loose ECG lead that resulted in a ventricular fibrillation arrest rhythm and (ii) a case of profound hypotension

Findings:

  • The LMA Supreme™ allowed effective ventilation during cardiac compressions, with no evidence of airway leak or ventilation impediment
  • The availability of a normal capnogram allowed the treating physicians to quickly

Implications:

  • Use of the LMA Supreme™ during cardiac arrest and resuscitation may be beneficial
  • The potential benefits of the LMA Supreme™ in this setting are a result of an ability to (i) rapidly secure the airway and achieve effective ventilation and (ii) continuously provide and monitor ventilation

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