Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-10T12:40:18.546Z Has data issue: false hasContentIssue false
  • English
  • Français

Feasibility of flexible lightwand-guided tracheal intubation with the intubating laryngeal mask during out-of-hospital cardiopulmonary resuscitation by an emergency physician

Published online by Cambridge University Press:  23 December 2005

V. Dimitriou ,
G. S. Voyagis ,
V. Grosomanidis  and
J. Brimacombe
V. Dimitriou
Affiliation:
‘G Genimmatas’ General Hospital of Athens, Athens, Greece
G. S. Voyagis
Affiliation:
‘Sotiria’ General Hospital of Athens, Athens, Greece
V. Grosomanidis
Affiliation:
AHEPA General Hospital of Thessaloniki, Thessaloniki, Greece
J. Brimacombe
Affiliation:
James Cook University, Cairns Base Hospital, Department of Anaesthesia and Intensive Care, Cairns, Australia
Get access

Extract

Summary

Background and objective: We tested the feasibility of using the intubating laryngeal mask airway Fastrach™ (ILMA) as a ventilatory device and for flexible lightwand-guided tracheal intubation for out-of-hospital cardiopulmonary resuscitation by an emergency physician. Methods: After completion of a training programme, a single experienced emergency physician used the technique for all patients requiring out-of-hospital tracheal intubation over a 10-month period. If access to the head and neck was limited, the intubating laryngeal mask airway was inserted from below and to the side, otherwise it was inserted from above the head. Data about the time for the ambulance to reach the patient, whether or not access to the head and neck was limited, whether or not circulation was successfully restored, and the insertion and intubation success rates were noted. Results: The mean (range) time for the ambulance to reach the patient was 12 (10–20) min. Access to the head and neck was limited in 8/37 (22%). Circulation was successfully restored in 10/37 (27%). The intubating laryngeal mask airway was successfully inserted at the first attempt in 35/37 (95%) and at the second attempt in 2/37 (5%). The tracheal tube was successfully inserted in 25/37 (67.5%) at the first attempt, 7/37 (19%) at the second attempt and 5/37 (13.5%) at the third attempt. There were no overall failures for intubating laryngeal mask airway insertion or tracheal intubation. There were no differences in success rate between positions. Oesophageal intubation was detected and corrected in 2/37 (5%). Conclusion: The intubating laryngeal mask airway has a high success rate as a ventilatory device and as a flexible lightwand-guided airway intubator during out-of-hospital cardiopulmonary resuscitation by a well-trained emergency physician. This technique may be particularly useful when there is limited access to the head and neck.

Keywords

LARYNGEAL MASKSINTUBATION INTRATRACHEALVENTILATION ARTIFICIALCARDIOPULMONARY RESUSCITATION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 1 , January 2006 , pp. 76 - 79
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2000; 102: I86–I89.
Grantham H, Phillips G, Gilligan JE. The laryngeal mask in pre-hospital emergency care. Emerg Med 1994; 6: 193–197.Google Scholar
Martin SE, Ochsner MG, Jarman RH et al. Use of the laryngeal mask airway in air transport when intubation fails. J Trauma 1999; 47: 352–357.Google Scholar
Rumball CJ, McDonald D. The PTL, combitube, laryngeal mask, and oral airway: A randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest. Prehosp Emerg Care 1997; 1: 1–10.Google Scholar
Tanigawa K, Shigematsu A. Choice of airway devices for 12,020 cases of nontraumatic cardiac arrest in Japan. Prehosp Emerg Care 1998; 2: 96–100.Google Scholar
Keller C, Brimacombe J. Pharyngeal mucosal pressures, airway sealing pressures and fiberoptic position with the intubating versus the standard laryngeal mask airway. Anesthesiology 1999; 90: 1001–1006.Google Scholar
Choyce A, Avidan MS, Patel C et al. Comparison of laryngeal mask and intubating laryngeal mask insertion by the naive intubator. Br J Anaesthesiol 2000; 84: 103–105.Google Scholar
Asai T, Wagle AU, Stacey M. Placement of the intubating laryngeal mask is easier than the laryngeal mask during manual in-line stabilisation. Br J Anaesthesiol 1999; 82: 712–714.Google Scholar
Brimacombe J. Conduit to the respiratory and gastrointestinal tracts. Laryngeal Mask Anesthesia. Principles and Practice, 2nd edn. London: WB Saunders, 2005: 153–176.
Gibbs M, Swanson E, Tayal V et al. Use of the intubating laryngeal mask airway in prehospital patients with failed rapid sequence intubation. Acad Emerg Med 2003: 10; 467 [Abstract].Google Scholar
Dimitriou V, Voyagis GS, Brimacombe J. Detection and correction of accidental oesophageal intubation during flexible lightwand-guided intubation via the intubating laryngeal mask. Anaesth Intens Care 2002; 30: 52–54.Google Scholar
Doerges V, Sauer C, Ocker H et al. Smaller tidal volumes during cardiopulmonary resuscitation: comparison of adult and paediatric self-inflatable bags with three different ventilatory devices. Resuscitation 1999; 43: 31–37.Google Scholar
Dimitriou V, Voyagis GS, Brimacombe J. Flexible lightwand-guided tracheal intubation with the intubating laryngeal mask Fastrach™ in adults following unpredicted failed laryngoscope-guided tracheal intubation. Anesthesiology 2002; 96: 296–299.Google Scholar
Koetter KP, Maleck WH. Reference for ice-pick position for intubation. Prehosp Emerg Care 1997; 1: 297 [Letter].Google Scholar
Greene MK, Roden R, Hinchley G. The laryngeal mask airway. Two cases of prehospital trauma care. Anaesthesia 1992; 47: 688–689.Google Scholar
Dimitriou V, Voyagis GS. Use of the intubating laryngeal mask for airway management and light-guided tracheal intubation in the lateral position. Eur J Anaesthesiol 2000; 17: 395–397.Google Scholar
Dimitriou V, Voyagis GS, Iatrou C, Brimacombe J. Flexible lightwand-guided intubation using the intubating laryngeal mask airway in the supine, right, and left lateral positions in healthy patients by experienced users. Anesth Analg 2003; 96: 896–898.Google Scholar
Brimacombe J. Placement phase. Laryngeal Mask Anesthesia. Principles and Practice, 2nd edn. London: WB Saunders, 2005: 265–280.
Ferson DZ, Rosenblatt WH, Johansen MJ et al. Use of the intubating LMA-Fastrach in 254 patients with difficult-to-manage airways. Anesthesiology 2001; 95: 1175–1181.Google Scholar
Brimacombe J. Anatomy. Laryngeal Mask Anesthesia. Principles and Practice, 2nd edn. London: WB Saunders, 2005: 73–104.
Brimacombe J. Difficult airway. Laryngeal Mask Anesthesia. Principles and Practice, 2nd edn. London: WB Saunders, 2005: 305–357.
Dimitriou V, Voyagis GS. Use of an illuminated flexible catheter for light-guided tracheal intubation through the intubating laryngeal mask by nurses. Eur J Anaesthesiol 2000; 17: 46–49.Google Scholar