Abstract 21: Laryngeal Mask Airway Use by Prehospital Personnel in Simulated Pediatric Arrest
Introduction: Pediatric respiratory arrest is a technically challenging scenario infrequently faced by prehospital providers. Previous studies indicate that prehospital endotracheal intubation results in worse neurologic outcome in these patients. Presently, there is no rescue airway for pediatric patients in this setting. We evaluated the pediatric laryngeal mask airway (LMA) as an alternative to bag-valve-mask (BVM) ventilation in a simulated prehospital pediatric respiratory arrest.
Hypothesis: Prehospital providers can successfully place and ventilate the pediatric LMA in a simulated pediatric respiratory arrest.
Methods: Paramedic students received a one-hour training session covering the use of the pediatric LMA. In random order, subjects performed airway management of a SimBaby manikin using both the LMA and the BVM. Rate of successful LMA placement, time to first ventilation, tidal volume by weight, and ventilations per minute were recorded. A generalized estimating equation analysis was completed to determine the effects of time and ventilation technique.
Results: All 13 subjects (100%) successfully ventilated the mannequin with both techniques. The median number of attempts required to successfully place the LMA was one. Median time from the start of the scenario to BVM ventilation was four seconds (IQR 3, 5) and the median to LMA ventilation was 30 seconds (IQR 25, 52). Tidal volumes were significantly greater with BVM ventilation [5.07 mL/kg (IQR 4.47, 5.43)] than with LMA ventilation [2.88 mL/kg (IQR 2.17, 4.04)]. An obvious air leak was present in all LMA cases, potentially resulting in reduced tidal volume delivery. Excessive ventilatory rates were noted in both BVM [42 ventilations per minute (IQR 33, 46)] and LMA [37ventilations per minute (IQR 31, 39)] groups.
Conclusions: Prehospital providers were able to place the LMA during simulated respiratory arrest although ventilation volumes were inadequate, and rates exceeded the recommended number in both BVM and LMA scenarios. Obvious air leakage was noted, and may represent a limitation of this simulation study.