Department of Emergency Services, Royal Victoria Hospital, Barrie, Ontario, Canada.
CJEM. 2002 Sep;4(5):338-43. doi: 10.1017/s1481803500007740.
The laryngeal mask airway (LMAtrade mark airway) provides adequate ventilation and offers a suitable alternative for airway management in patients with cardiac arrest if primary care paramedics do not have intubation skills or are unable to intubate. Training in the use of the LMA usually occurs in the operating room.
To describe the use of the LMA by paramedics in prehospital adult non-traumatic cardiac arrest patients after classroom mannequin training. The study took place in a suburban rural emergency medical service.
This is a 2-phase observational study of the effect of paramedic training for LMA insertion using a mannequin and the success rate in the prehospital setting. All paramedics successfully completed classroom mannequin training. All subsequent prehospital adult non-traumatic cardiac arrest patients from mid-February 1999 to Mar. 31, 2000, were eligible. Subjective assessment of chest expansion, ease of ventilation and auscultation defined adequacy of ventilation. Data collected included the number of insertion attempts, reasons for failure, ease of insertion, adverse events and reasons for not attempting intubation. Statistical analysis comprised descriptive frequencies, chi-squared tests for comparison of categorical variables and analysis of variance for continuous variables.
208 paramedics (100%) successfully completed training. The mean number of attempts was 1, and only 4 (2.1%) paramedics required a second attempt with a mannequin. The paramedics' perception of ease of use comparing the LMA with a bag valve mask (BVM) was evenly distributed across the 3 descriptors: 70 (39%) scored the LMA as easier to use, 57 (31%) as more difficult, and 54 (30%) stated there would be no difference. Of the 291 arrests during the study period, insertion of the LMA was attempted in 283 (97.3%) and was successful in 199 (70%) patients. The LMA became dislodged in 5 (2.5%) cases and was removed in 12 (6%) to clear vomit from the airway. The overall success rate was 182 (64%). The incidence of regurgitation prior to attempted insertion of the LMA was 28% (79 patients). Success rates did not vary significantly with the incidence of vomiting prior to insertion (p = 0.11). The majority of the paramedics evaluated LMA insertion as Very easy 49/220 (22.3%) or Easy 87/220 (39.6%). Paramedic evaluation of ease of use varied with success (p = 0.001).
This study reports a 100% training success rate with a mannequin and a 64% success with LMA insertion and ventilation in the field by paramedics among adult out-of-hospital non-traumatic cardiac arrest patients.
喉罩（LMAtrade mark 气道）在初级急救护理人员没有插管技能或无法插管的情况下，为心脏骤停患者的气道管理提供了足够的通气，并提供了合适的替代方法。LMA 的使用培训通常在手术室进行。
描述在心肺复苏期间使用 LMA 对非创伤性心搏骤停成年患者进行院前管理的效果。该研究在一个郊区农村急救医疗服务中心进行。
这是一项关于使用模型进行 LMA 插入的效果的 2 阶段观察性研究，以及在院前环境中的成功率。所有的护理人员都成功地完成了课堂模型培训。所有随后的 1999 年 2 月中旬至 2000 年 3 月 31 日期间发生的非创伤性心搏骤停的成年患者都符合条件。主观评估胸部扩张、通气的容易程度和听诊定义了通气的充分性。收集的数据包括插入尝试的次数、失败的原因、插入的容易程度、不良事件和未尝试插管的原因。统计分析包括描述性频率、分类变量的卡方检验和连续变量的方差分析。
208 名护理人员（100%）成功完成了培训。平均尝试次数为 1 次，只有 4 名（2.1%）护理人员需要在模型上进行第二次尝试。护理人员在使用 LMA 与袋式面罩（BVM）的易用性方面的看法在 3 个描述符上均匀分布：70 名（39%）将 LMA 评为更易于使用，57 名（31%）评为更难，54 名（30%）表示没有区别。在研究期间的 291 次心跳骤停中，283 次（97.3%）尝试插入 LMA，199 次（70%）患者成功。LMA 有 5 次（2.5%）移位，12 次（6%）被移除，以清除气道中的呕吐物。总体成功率为 182 次（64%）。在尝试插入 LMA 之前，反流的发生率为 28%（79 名患者）。在插入前呕吐的发生率与成功率之间没有显著差异（p = 0.11）。大多数护理人员将 LMA 插入评估为非常容易 49/220（22.3%）或容易 87/220（39.6%）。护理人员对易用性的评估随成功率而变化（p = 0.001）。
本研究报告了一项 100%的培训成功率，以及在非创伤性院外心脏骤停成年患者中，护理人员在现场使用 LMA 进行通气的成功率为 64%。
