Effectiveness of Intubating Laryngeal Mask Airway in managing out-of-hospital cardiac arrest by non-physicians. (March 2019)

• Record Type: Journal Article
• Authors: Lemaitre, Elena-Laura; Tritsch, Laurent; Noll, Eric; Diemunsch, Pierre; Meyer, Nicolas
• Is Part Of: Resuscitation. Volume 136(2019)
• Page Start: 61
• Page End: 69
• Publication Date: 2019-03
• Subjects: Out-of-hospital cardiac arrest -- Emergency medical services -- Airway management -- Endotracheal intubation -- Supraglottic airway devices -- Paramedics; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2018.12.004
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim of the study: The role of supraglottic devices in airway management in out-of-hospital cardiac arrest (OHCA) remains controversial. The aim of this study was to evaluate the feasibility and effectiveness of intubation through the Intubating Laryngeal Mask Airway (ILMA) when used by prehospital emergency nurses in the setting of OHCA. Methods: We conducted a prospective, observational trial during 12 years by the Fire Department and prehospital emergency service of the health district of Strasbourg, France. The primary outcome was the success rate of ventilation after intubation through the ILMA, while the secondary outcomes were the success rate of ventilation after insertion of the ILMA and complications related to ILMA placement and intubation. Factors associated with successful intubation were also studied. Results: During the study period, 1464 ILMA placements were attempted by emergency nurses during OHCA. Ventilation was possible in 1250 patients (85.38%) after ILMA placement and in 1078 patients (73.63%) after intubation. Regurgitation of gastric contents occurred in 237 (16.18%) patients, mostly during basic life support. Two factors were predictive of a successful tracheal intubation: the performance of the Chandy maneuver OR = 2.91 (CI: 2.07–3.97) and the number of attempts at intubation OR = 1.95 (CI: 1.43–2.61). Conversely, the number of attempts at ILMA insertion was predictive of an intubation failure OR = 0.11 (CI: 0.07–0.17). Conclusion: The success rate of intubation through the ILMA was high. After ILMA placement, ventilation was possible in 1250 patients (85.38%) and in 1078 patients (73.63%) after intubation.