Quite agree about OP airways - totally disgaree with LMAs - most RTOs are training junior nursing staff that are non-ALS how to use LMAs - and we train all our technicians and Community First Responders. Aspiration rates about a third less than OP airways and much easier to use than manual airway opening skills.

In addition, mannikin training has been shown to be aas effective as in-threatre training.

In trauma, would only really be used in patients that are bradypnoeic where respiration being supported/provided.

Very useful in driver RTAs where can only access the airway from the side of the patient.

Eur J Emerg Med. 1994 Sep;1(3):123-5.
Immediate management of the airway during cardiopulmonary resuscitation in a hospital without a resident anaesthesiologist.
Verghese C, Prior-Willeard PF, Baskett PJ.
Royal Berkshire Hospital, Reading, UK.

The effect of withdrawing the resident anaesthesiologist from the cardiopulmonary resuscitation (CPR) team was audited over a 1-year period in a 407-bed hospital in which nurses had been trained in the use of the laryngeal mask airway (LMA) as a first response airway in CPR. The data were compared to those of the previous year, which are shown in parentheses. During the audit period, there were 115 (79) calls to 115 (79) patients; the immediate airway was secured using a mask bag valve assembly in 75 (49) episodes, the Laerdal pocket mask in 2 (2) episodes, the LMA in 64 (2) and the endotracheal tube in 20 (57). Return of spontaneous circulation occurred in 61% (36%). There were no instances of failure to maintain the immediate airway during the audit period. Initial results suggest that an anaesthesiologist may not be essential for the provision of an immediate airway in patients requiring CPR.


Resuscitation. 1997 Jan;33(3):211-4.
Airway management training using the laryngeal mask airway: a comparison of two different training programmes.
Roberts I, Allsop P, Dickinson M, Curry P, Eastwick-Field P, Eyre G.
Department of Anaesthesia, Burton Hospitals NHS Trust, Burton-on-Trent, Staffordshire, UK.

Nurses without prior experience in the use of the laryngeal mask airway (LMA) were randomly allocated to one of two groups to be trained in the emergency technique of insertion of an LMA. Group A (32 nurses) were trained only on a manikin and group B (20 nurses) were trained on a manikin and with live anaesthetised patient practice in theatre (five successful insertions). Without further practice, both groups were asked to insert an LMA in a live patient in theatre 3 months after initial training. Three attempts per nurse were allowed. In group A, 75% passed the LMA successfully at the first attempt, 22% at the second attempt and 3% (one nurse) at the third attempt. In group B, 80% were successful at first attempt and 20% at the second attempt. Skill performance and retention were shown to be high following either training method, with no significant difference between the performance of either group (chi 2). We have shown that manikin-only training in the emergency techniqu!
e for LMA insertion is as effective as live patient training. It is proposed that manikin training alone may be adopted as a future training modality if, as is expected, the use of the LMA in resuscitation becomes more commonplace.


Resuscitation. 1994 Oct;28(2):103-6.
The role of laryngeal mask airway in cardiopulmonary resuscitation.
Samarkandi AH, Seraj MA, el Dawlatly A, Mastan M, Bakhamees HB.
Department of Anaesthesia, King Khalid University Hospital, Riyadh, Saudi Arabia.

The laryngeal mask airway (LMA) has been newly introduced to anaesthesia practice as an alternative to the endotracheal tube (ETT) or face mask for airway management. It is capable of providing a rapid and easily achieved patent airway that permits positive pressure ventilation within confined limits. In this study, we aim to evaluate the role of the LMA in cardiopulmonary resuscitation (CPR) in 20 patients as an alternative to tracheal intubation. Study parameters included measurement of oxygen saturation by a pulse oximeter and end-tidal carbon dioxide level (ETCO2) using the Fenem CO2 analyser. Five of these 20 cases were resuscitated using endotracheal tubes as a control group. Seven cases were resuscitated using LMA only and eight cases were resuscitated using LMA initially followed by ETT for long term ventilation. In the LMA groups I and III, 12 patients had LMA inserted at the first attempt and three at a second attempt. We concluded that LMA is a good alternative to!
 ETT, although it may not protect against aspiration. We recommend it to be included in CPR chart cards and all medical doctors, nurses and paramedical staff should learn how to use it.

Cheers
Anton

In message <[log in to unmask]> Rowley Cottingham <[log in to unmask]> writes:
> > For health care workers with only basic life support skills, it
> > provides a better form of airway than an OP airway with a lower
> > aspiration rate - main problem is with clenhed teeth when only a
> > nasopharyngeal airway will suffice.
> >
> > Anton
> > Staffs
>
> "Health care workers with only basic life support skills" should not be taught either OP or LMA.
> They will only be using it very rarely indeed and there is a serious issue with skills retention.
>
> Best wishes,
>
>
> Rowley Cottingham
>
> [log in to unmask]
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