EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial

Anna Fiala, Wolfgang Lederer, Agnes Neumayr, Tamara Egger, Sabrina Neururer, Ernst Toferer, Michael Baubin, Peter Paal, Anna Fiala, Wolfgang Lederer, Agnes Neumayr, Tamara Egger, Sabrina Neururer, Ernst Toferer, Michael Baubin, Peter Paal

Abstract

Background: Laryngeal tube (LT) application by rescue personnel as an alternate airway during the early stages of out-of-hospital cardiac arrest (OHCA) is still subject of debate. We evaluated ease of handling and efficacy of ventilation administered by emergency medical technicians (EMTs) using LT and bag-valve-mask (BVM) during cardiopulmonary resuscitation of patients with OHCA.

Methods: An open prospective randomized multicenter study was conducted at six emergency medical services centers over 18 months. Patients in OHCA initially resuscitated by EMTs were enrolled. Ease of handling (LT insertion, tight seal) and efficacy of ventilation (chest rises visibly, no air leak) with LT and BVM were subjectively assessed by EMTs during pre-study training and by the attending emergency physician on the scene. Outcome and frequency of complications were compared.

Results: Of 97 eligible patients, 78 were enrolled. During pre-study training EMTs rated efficacy of ventilation with LT higher than with BVM (66.7% vs. 36.2%, p = 0.022), but efficacy of on-site ventilation did not differ between the two groups (71.4% vs. 58.5%, p = 0.686). Frequency of complications (11.4% vs. 19.5%, p = 0.961) did not differ between the two groups.

Conclusions: EMTs preferred LT ventilation to BVM ventilation during pre-study training, but on-site there was no difference with regard to efficacy, ventilation safety, or outcome. The results indicate that LT ventilation by EMTs during OHCA is not superior to BVM and cannot substitute for BVM training. We assume that the main benefit of the LT is the provision of an alternative airway when BVM ventilation fails. Training in BVM ventilation remains paramount in EMT apprenticeship and cannot be substituted by LT ventilation.

Trial registration: ClinicalTrials.gov (NCT01718795).

Keywords: Airway management; Cardiac arrest; Cardiopulmonary resuscitation; Laryngeal tube; Prehospital emergency medicine.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Ethics Committee of the Medical University of Innsbruck, Austria (AN4355–300/4.15).

Consent for publication

Consent of relatives was planned to be sought “post hoc” after enrolment and treatment on site but was not necessary during the study. Patients’ informed written consent in those who survived with good cerebral performance was planned to be obtained during recovery. Written informed consent from EMTs was obtained after successful training and from EMS physicians after general information was provided at the centers. Written consent of the EMS was given by the designated Medical Director. Comprehensive insurance coverage for patients and EMTs was provided by Innsbruck Medical University Hospital.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow Diagram (Consort 2010) of patient enrolment, randomization, allocation, and analysis

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Source: PubMed

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