Safety and feasibility of the laryngeal tube when used by emergency medical technicians during out-of-hospital cardiac arrest - 08/05/15

Doi : 10.1016/j.ajem.2015.04.048

Dominik Roth, MD ^a, Christina Hafner, MD ^a,^b, Werner Aufmesser, MD ^c, Kurt Hudabiunigg, MD ^c, Christian Wutti, MD ^c, Harald Herkner, MD, MSc ^a,^{^⁎} , Wolfgang Schreiber, MD ^a,^c
^a Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
^b Department of Anaesthesiology and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
^c Austrian Red Cross, Vienna, Austria

^⁎Corresponding author at: Department of Emergency Medicine, Medical University Vienna, General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria. Tel.: +43 1 40400 39640; fax: +43 1 40400 19650.

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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.

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