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The intuitive use of laryngeal airway devices by lay responders
Critical Care volume 8, Article number: P291 (2004)
In cardiopulmonary resuscitation, securing the airway is of paramount importance. Even if intubating the trachea can still be seen as the gold standard, it is still reserved for experts and healthcare professsionals. However, the insertion of a laryngeal airway device offers – compared with bag-valve face ventilation – the opportunity to ventilate a patient effectively. Moreover, it can also be placed easily by lay responders.
We put forth the hypothesis that a laryngeal airway device can be placed intuitively without any background knowledge about the device. A simple but well-directed training programme can even improve the performance. The aim of the study was to investigate the intuitive use of different airway devices by first-year medical students.
Devices tested were the LMA-Classic and the LMA-FastTrach. Subjects embodied were 139 medical students. They were evaluated on an airway trainer regarding, mainly, the time until correct placement of the device, the number of attempts and the initial tidal volume. The trachea of the the mannequin was therefore connected with a volumeter. An initial tidal volume < 150 ml was considered insufficient and excluded from further data analysis. A second evaluation was done after a specific training programme.
Twenty from 79 subjects out of the LMA-Classic group and 11 from 60 subjects out of the LMA-FastTrach group had an initial tidal volume < 150 ml. The measured tidal volume was 673.7 ± 133.1 ml for the LMA-Classic and 1057.7 ± 158.5 ml for the LMA-FastTrach. The mean time to correct placement was 55.5 ± 29.6 s for the LMA-Classic and 38.1 ± 24.9 s for the LMA-FastTrach. In the second evaluation, initial tidal volume < 150 ml was recorded in 14 out of 79 subjects for the LMA-Classic and in six out of 60 subjects for the LMA-FastTrach. The time to correct placement decreased significantly, with 22.9 ± 13.5 s for the LMA-Classic and 22.9 ± 19.0 s for the LMA-FastTrach. The measured tidal volume was 777.6 ± 367.9 ml for the LMA-Classic versus 1018.4 ± 50.7 ml for the LMA-FastTrach.
Untrained laypersons are able to use different airway devices and can therefore provide effective ventilation even without having any detailed background knowledge about the instrument. Minimal theoretical instruction and practical skill training of 2 hours overall can improve the students' performance significantly. This result underlines the idea of implementing laryngeal airway devices into basic life support (BLS). Specific BLS programmes combined with airway management need to be developed. Value has to be put on general instructions. Describing specific technical details is not useful. Keeping the instructions to laypersons as simple as possible will additionally lead to more acceptance and motivation on performing BLS.
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Bickenbach, J., Schaelte, G., Beckers, S. et al. The intuitive use of laryngeal airway devices by lay responders. Crit Care 8, P291 (2004). https://doi.org/10.1186/cc2758
- Medical Student
- Tidal Volume
- Background Knowledge
- Airway Management
- Practical Skill