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. 2001 Mar;18(2):90–94. doi: 10.1136/emj.18.2.90

Emergency airway management by non-anaesthesia house officers—a comparison of three strategies

V Dorges 1, H Ocker 1, V Wenzel 1, C Sauer 1, P Schmucker 1
PMCID: PMC1725532  PMID: 11300206

Abstract

Objectives—The purpose of this study was to determine effects of different airway devices and tidal volumes on lung ventilation and gastric inflation in an unprotected airway.

Methods—Thirty one non-anaesthesia house officers volunteered for the study, and ventilated a bench model simulating an unintubated respiratory arrest patient with bag-valve-facemask, laryngeal mask airway, and combitube using paediatric and adult self inflating bags.

Results—The paediatric versus adult self inflating bag resulted with the laryngeal mask airway and combitube in significantly (p<0.001) lower mean (SEM) lung tidal volumes (376 (30) v 653 (47) ml, and 368 (28) v 727 (53) ml, respectively). Gastric inflation was zero with the combitube; and 0 (0) v 8 (3) ml with the laryngeal mask airway with low versus large tidal volumes. The paediatric versus adult self inflating bag with the bag-valve-facemask resulted in comparable lung tidal volumes (245 (19) v 271 (33) ml; p=NS); but significantly (p<0.001) lower gastric tidal volume (149 (11) v 272 (24) ml).

Conclusions—The paediatric self inflating bag may be an option to reduce the risk of gastric inflation when using the laryngeal mask airway, and especially, the bag-valve-facemask. Both the laryngeal mask airway and combitube proved to be valid alternatives for the bag-valve-facemask in this experimental model.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Atherton G. L., Johnson J. C. Ability of paramedics to use the Combitube in prehospital cardiac arrest. Ann Emerg Med. 1993 Aug;22(8):1263–1268. doi: 10.1016/s0196-0644(05)80104-0. [DOI] [PubMed] [Google Scholar]
  2. Baskett P., Nolan J., Parr M. Tidal volumes which are perceived to be adequate for resuscitation. Resuscitation. 1996 Jun;31(3):231–234. doi: 10.1016/0300-9572(96)00994-x. [DOI] [PubMed] [Google Scholar]
  3. Brimacombe J. The advantages of the LMA over the tracheal tube or facemask: a meta-analysis. Can J Anaesth. 1995 Nov;42(11):1017–1023. doi: 10.1007/BF03011075. [DOI] [PubMed] [Google Scholar]
  4. Dobson A. P., McCluskey A., Meakin G., Baker R. D. Effective time to satisfactory intubation conditions after administration of rocuronium in adults. Comparison of propofol and thiopentone for rapid sequence induction of anaesthesia. Anaesthesia. 1999 Feb;54(2):172–176. doi: 10.1046/j.1365-2044.1999.00655.x. [DOI] [PubMed] [Google Scholar]
  5. Doerges V., Sauer C., Ocker H., Wenzel V., Schmucker P. Airway management during cardiopulmonary resuscitation--a comparative study of bag-valve-mask, laryngeal mask airway and combitube in a bench model. Resuscitation. 1999 Jun;41(1):63–69. doi: 10.1016/s0300-9572(99)00036-2. [DOI] [PubMed] [Google Scholar]
  6. Doerges V., Sauer C., Ocker H., Wenzel V., Schmucker P. Smaller tidal volumes during cardiopulmonary resuscitation: comparison of adult and paediatric self-inflatable bags with three different ventilatory devices. Resuscitation. 1999 Dec;43(1):31–37. doi: 10.1016/s0300-9572(99)00117-3. [DOI] [PubMed] [Google Scholar]
  7. Dörges V., Ocker H., Hagelberg S., Wenzel V., Idris A. H., Schmucker P. Smaller tidal volumes with room-air are not sufficient to ensure adequate oxygenation during bag-valve-mask ventilation. Resuscitation. 2000 Mar;44(1):37–41. doi: 10.1016/s0300-9572(99)00161-6. [DOI] [PubMed] [Google Scholar]
  8. Dörges V., Ocker H., Hagelberg S., Wenzel V., Schmucker P. Optimisation of tidal volumes given with self-inflatable bags without additional oxygen. Resuscitation. 2000 Feb;43(3):195–199. doi: 10.1016/s0300-9572(99)00148-3. [DOI] [PubMed] [Google Scholar]
  9. Frass M., Frenzer R., Rauscha F., Weber H., Pacher R., Leithner C. Evaluation of esophageal tracheal combitube in cardiopulmonary resuscitation. Crit Care Med. 1987 Jun;15(6):609–611. doi: 10.1097/00003246-198706000-00015. [DOI] [PubMed] [Google Scholar]
  10. Frass M., Frenzer R., Zdrahal F., Hoflehner G., Porges P., Lackner F. The esophageal tracheal combitube: preliminary results with a new airway for CPR. Ann Emerg Med. 1987 Jul;16(7):768–772. doi: 10.1016/s0196-0644(87)80571-1. [DOI] [PubMed] [Google Scholar]
  11. Ho-Tai L. M., Devitt J. H., Noel A. G., O'Donnell M. P. Gas leak and gastric insufflation during controlled ventilation: face mask versus laryngeal mask airway. Can J Anaesth. 1998 Mar;45(3):206–211. doi: 10.1007/BF03012903. [DOI] [PubMed] [Google Scholar]
  12. Krischer J. P., Fine E. G., Davis J. H., Nagel E. L. Complications of cardiac resuscitation. Chest. 1987 Aug;92(2):287–291. doi: 10.1378/chest.92.2.287. [DOI] [PubMed] [Google Scholar]
  13. Lawes E. G., Baskett P. J. Pulmonary aspiration during unsuccessful cardiopulmonary resuscitation. Intensive Care Med. 1987;13(6):379–382. doi: 10.1007/BF00257678. [DOI] [PubMed] [Google Scholar]
  14. Martin P. D., Cyna A. M., Hunter W. A., Henry J., Ramayya G. P. Training nursing staff in airway management for resuscitation. A clinical comparison of the facemask and laryngeal mask. Anaesthesia. 1993 Jan;48(1):33–37. [PubMed] [Google Scholar]
  15. Ornato J. P., Bryson B. L., Donovan P. J., Farquharson R. R., Jaeger C. Measurement of ventilation during cardiopulmonary resuscitation. Crit Care Med. 1983 Feb;11(2):79–82. doi: 10.1097/00003246-198302000-00004. [DOI] [PubMed] [Google Scholar]
  16. Pepe P. E., Zachariah B. S., Chandra N. C. Invasive airway techniques in resuscitation. Ann Emerg Med. 1993 Feb;22(2 Pt 2):393–403. doi: 10.1016/s0196-0644(05)80470-6. [DOI] [PubMed] [Google Scholar]
  17. RUBEN H., KNUDSEN E. J., CARUGATI G. Gastric inflation in relation to airway pressure. Acta Anaesthesiol Scand. 1961;5:107–114. doi: 10.1111/j.1399-6576.1961.tb00089.x. [DOI] [PubMed] [Google Scholar]
  18. SAFAR P., AGUTO-ESCARRAGA L. Compliance in apneic anesthetized adults. Anesthesiology. 1959 May-Jun;20(3):283–289. doi: 10.1097/00000542-195905000-00005. [DOI] [PubMed] [Google Scholar]
  19. Smith S. C., Jr AHA president's letter. Circulation. 1995 Jul 1;92(1):1–1. [PubMed] [Google Scholar]
  20. Stone B. J., Chantler P. J., Baskett P. J. The incidence of regurgitation during cardiopulmonary resuscitation: a comparison between the bag valve mask and laryngeal mask airway. Resuscitation. 1998 Jul;38(1):3–6. doi: 10.1016/s0300-9572(98)00068-9. [DOI] [PubMed] [Google Scholar]
  21. Tolley P. M., Watts A. D., Hickman J. A. Comparison of the use of the laryngeal mask and face mask by inexperienced personnel. Br J Anaesth. 1992 Sep;69(3):320–321. doi: 10.1093/bja/69.3.320. [DOI] [PubMed] [Google Scholar]
  22. Verghese C., Prior-Willeard P. F., Baskett P. J. Immediate management of the airway during cardiopulmonary resuscitation in a hospital without a resident anaesthesiologist. Eur J Emerg Med. 1994 Sep;1(3):123–125. [PubMed] [Google Scholar]
  23. Weiler N., Heinrichs W., Dick W. Assessment of pulmonary mechanics and gastric inflation pressure during mask ventilation. Prehosp Disaster Med. 1995 Apr-Jun;10(2):101–105. doi: 10.1017/s1049023x00041807. [DOI] [PubMed] [Google Scholar]
  24. Weiler N., Latorre F., Eberle B., Goedecke R., Heinrichs W. Respiratory mechanics, gastric insufflation pressure, and air leakage of the laryngeal mask airway. Anesth Analg. 1997 May;84(5):1025–1028. doi: 10.1097/00000539-199705000-00013. [DOI] [PubMed] [Google Scholar]
  25. Wenzel V., Idris A. H., Banner M. J., Kubilis P. S., Band R., Williams J. L., Jr, Lindner K. H. Respiratory system compliance decreases after cardiopulmonary resuscitation and stomach inflation: impact of large and small tidal volumes on calculated peak airway pressure. Resuscitation. 1998 Aug;38(2):113–118. doi: 10.1016/s0300-9572(98)00095-1. [DOI] [PubMed] [Google Scholar]
  26. Wenzel V., Idris A. H., Banner M. J., Kubilis P. S., Williams J. L., Jr Influence of tidal volume on the distribution of gas between the lungs and stomach in the nonintubated patient receiving positive-pressure ventilation. Crit Care Med. 1998 Feb;26(2):364–368. doi: 10.1097/00003246-199802000-00042. [DOI] [PubMed] [Google Scholar]
  27. Wenzel V., Keller C., Idris A. H., Dörges V., Lindner K. H., Brimacombe J. R. Effects of smaller tidal volumes during basic life support ventilation in patients with respiratory arrest: good ventilation, less risk? Resuscitation. 1999 Dec;43(1):25–29. doi: 10.1016/s0300-9572(99)00118-5. [DOI] [PubMed] [Google Scholar]

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