Effectiveness of an intubating laryngeal mask airway (ILMA Fastrach) used by nurses during out-of-hospital cardiac arrest resuscitation

Introduction

ILMA Fastrach is a good alternative to difficult endotracheal intubation even by an untrained physician but has never been studied in a out-of-hospital setting. Our aim was to evaluate the efficiency of this device used by untrained nurses in out-of-hospital cardiac arrest (OHCA).

Method

After a brief instruction course and training on a mannequin, 12 nurses used ILMA Fastrach during 71 OHCA(s) resuscitation in a prospective open study. Procedure took place under the supervision of a certified emergency physician while ambulance officers applied basic life support. The ILMA size was selected according to the manufacturer's instructions and they were lubricated before insertion. Effective ventilation after mask insertion was verified by presence of ample chest movement and correct intubation was verified by the physician (chest auscultation) and by capnography. A digital voice recorder recorded speed and success rates. After two unsuccessful attempts, the physician performed classic intubation.

Results

Effective ventilation after mask insertion was obtained in 97% (65/67); in the two unsuccessful cases, one was hanged and one had a literalised larynx (these data were not collected in four patients because of a recording problem). The rate of successful endotracheal intubation was 75% (53/71) after the first attempt and 89% (63/71) after the second. In the eight unsuccessful cases, ventilation with the mask was effective. The total mean time of intubation (since inclusion) was 148 s with a mean time of 53 s to prepare the device. The physician easily intubated all the eight remaining patients: a cephalic larynx was noticed in the five cases (mask size 5 chosen), one was hanged, and no abnormalities were in the two others.

Conclusion

The ILMA Fastrach is a good alternative to classical intubation by untrained nurse OHCA resuscitations. The patient could be ventilated after mask insertion in most cases and the time to perform intubation is short. However, 1 min is necessary to prepare the device, so a good training and preparation of the material is necessary. Results are not as favourable as in the operative room and the effectiveness of ventilation with the mask was not predictive of intubation. However, only two unsuccessful attempts were permitted before classical intubation and the size according to the weight was inadequate in five cases. A large multicenter study is warranted to confirm these results.