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Volume 5 Supplement 5

21st International Symposium on Intensive Care and Emergency Medicine

A laboratory assessment of the learning and retention of skills required to use the Combitube and Laryngeal Mask Airway by non-anaesthetists

Both the Combitube and Laryngeal Mask Airway (LMA) have been successfully used by non-anaesthetists during resuscitation [1,2,3,4,5]. However, only one study (using the Combitube) has assessed how well these skills are retained after the initial training period. Here, nine of 11 paramedics demonstrated inadequate skill retention in the follow-up study at 15 months [6].

Study purpose

To assess and compare the ability of non-anaesthetists to learn and retain the skills necessary to use the Combitube and Laryngeal Mask Airways.

Method

With no prior warning, 10 non-anaesthetists (3 student nurses, 2 qualified nurses and 5 trainee operating department practitioners) took part in a study morning covering theoretical aspects of Combitube and LMA insertion and use, and a practical demonstration and practice session. This was followed by a written examination of 30 yes/no questions and a practical assessment for each airway device. Eight weeks later, again with no prior warning, the same 10 people retook the same written examinations and practical assessments.

Results

The mean decrease in score between the first and second visits was -1.3 (95% confidence limits, -0.13 to -2.47; P < 0.05) for the Combitube, and -0.5 (95% confidence limits, 0.63 to -1.63; P < 0.5) for the LMA.

Conclusion

This study suggests that the practical use of the Combitube is an easier skill to acquire than the LMA. Not surprisingly retention of theoretical and practical skills for both the Combitube and LMA deteriorated over a short time span (although not reaching statistical significance for theoretical LMA scores). Therefore, whatever airway device non-anaesthetists are taught to use, regular refresher courses will be needed.

However, larger numbers need to be studied to corroborate these findings.

Table 1 Results of written examinations (means quoted)
Table 2 Results of practical assessments

References

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    Calkins MD, Robinson TD: Combat trauma airway management: endotracheal intubation versus laryngeal mask airway versus combitube use by Navy SEAL and Reconnaissance combat corpsmen. J Trauma 1999, 46: 927-932. 10.1097/00005373-199905000-00025

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    Blostein PA, Koestner AJ, Hoak S: Failed rapid sequence intubation in trauma patients: esophageal tracheal combitube is a useful adjunct. J Trauma 1998, 44: 534-537. 10.1097/00005373-199803000-00021

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    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. 10.1080/10903129808958850

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    Rumball CJ, MacDonald 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. 10.1080/10903129708958776

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    Atherton GL, Johnson JC: Ability of paramedics to use the Combitube in prehospital cardiac arrest. Ann Emerg Med 1993, 22: 1263-1268. 10.1016/S0196-0644(05)80104-0

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Coles, C., Elding, C. & Mercer, M. A laboratory assessment of the learning and retention of skills required to use the Combitube and Laryngeal Mask Airway by non-anaesthetists. Crit Care 5, P004 (2001). https://doi.org/10.1186/cc1075

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Keywords

  • Confidence Limit
  • Laryngeal Mask Airway
  • Student Nurse
  • Practical Skill
  • Short Time Span