Gastric rupture and laryngeal mask airway

Editor—Case reports have always been useful in increasing awareness of some issues not apparent when new procedures or techniques are introduced. Haslam et al describe gastric rupture associated with use of the laryngeal mask airway during cardiopulmonary resuscitation.¹ I believe that the use of the laryngeal mask airway has been pivotal in managing the airway by non-anaesthetists, especially in prehospital settings. Recent literature agrees that attempting to use orotracheal intubation in prehospital environments actually worsens outcomes compared with “simpler” methods such as bag-valve mask ventilation.

I am concerned that the “hype” that this case report might generate may deter people from using a device as excellent as the laryngeal mask airway because of concerns of producing gastric rupture and pneumoperitoneum.

This report should be used as a reminder that any tool can potentially produce harm, and that the benefits of this tool's prehospital use exceed the harm by far. Tidal volumes and insufflation pressures should always be monitored, no matter which airway device is used; and appropriate resuscitation bags to facilitate this should be made available.