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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2012 | Original research

Does a 4 diagram manual enable laypersons to operate the laryngeal mask supreme^®? A pilot study in the manikin

Authors: Gereon Schälte, Christian Stoppe, Rolf Rossaint, Laura Gilles, Maike Heuser, Steffen Rex, Mark Coburn, Norbert Zoremba, Annette Rieg

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2012

Abstract

Background

Bystander resuscitation plays an important role in lifesaving cardiopulmonary resuscitation (CPR). A significant reduction in the "no-flow-time", quantitatively better chest compressions and an improved quality of ventilation can be demonstrated during CPR using supraglottic airway devices (SADs). Previous studies have demonstrated the ability of inexperienced persons to operate SADs after brief instruction. The aim of this pilot study was to determine whether an instruction manual consisting of four diagrams enables laypersons to operate a Laryngeal Mask Supreme^® (LMAS) in the manikin.

Methods

An instruction manual of four illustrations with speech bubbles displaying the correct use of the LMAS was designed. Laypersons were handed a bag containing a LMAS, a bag mask valve device (BMV), a syringe prefilled with air and the instruction sheet, and were asked to perform and ventilate the manikin as displayed. Time to ventilation was recorded and degree of success evaluated.

Results

A total of 150 laypersons took part. Overall 145 participants (96.7%) inserted the LMAS in the manikin in the right direction. The device was inserted inverted or twisted in 13 (8.7%) attempts. Eight (5.3%) individuals recognized this and corrected the position. Within the first 2 minutes 119 (79.3%) applicants were able to insert the LMAS and provide tidal volumes greater than 150 ml (estimated dead space). Time to insertion and first ventilation was 83.2 ± 29 s. No significant difference related to previous BLS training (P = 0.85), technical education (P = 0.07) or gender could be demonstrated (P = 0.25).

Conclusion

In manikin laypersons could insert LMAS in the correct direction after onsite instruction by a simple manual with a high success rate. This indicates some basic procedural understanding and intellectual transfer in principle. Operating errors (n = 91) were frequently not recognized and corrected (n = 77). Improvements in labeling and the quality of instructional photographs may reduce individual error and may optimize understanding.

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Handley AJ, Koster R, Monsieurs K, Perkins GD, Davies S, Bossaert L, European Resuscitation Council: European Resuscitation Council guidelines for resuscitation 2005. Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation. 2005, 67 (Suppl 1): S7-S23.CrossRefPubMed

Wiese CH, Bartels U, Bahr J, Graf BM: Kurs Lebensrettende Sofortmaßnahmen, Überprüfung der theoretischen Kenntnisse von Teilnehmern. Notfall Rettungsmed. 2006, 9: 597-603. 10.1007/s10049-006-0852-9.CrossRef

Burghofer K, Schlechtriemen T, Lackner CK: Konsequenzen aus der Altruismusforschung für die Ausbildung in Erster Hilfe. Notfall Rettungsmed. 2005, 8: 408-411. 10.1007/s10049-005-0762-2.CrossRef

Baubin M: Laienreanimation ohne Mund-zu-Mund-Beatmung?. Anaesthesist. 2007, 56: 897-898. 10.1007/s00101-007-1245-2.CrossRef

Kreimeier U, Dirks B, Arntz HR, Bahr J, Goldschmidt P, Roessler M, Sasse M, Toursarkissian M: Stellenwert der Beatmung bei der Laienreanimation, Bestätigung der Gültigkeit der European Resuscitation Council (ERC) Guidelines 2005". Notfall Rettungsmed. 2005, 11: 340-343.CrossRef

Bur A, Kittler H, Sterz F, Holzer M, Eisenburger P, Oschatz E, Kofler J, Laggner AN: Effects of bystander first aid, defibrillation and advanced life support on neurologic outcome and hospital costs in patients after ventricular fibrillation cardiac arrest. Intensive Care Med. 2001, 27: 1474-1480. 10.1007/s001340101045.CrossRefPubMed

Herlitz J, Engdahl J, Svensson L, Angquist KA, Young M, Holmberg S: Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden. Am Heart J. 2005, 149: 61-66. 10.1016/j.ahj.2004.07.014.CrossRefPubMed

Bahr J, Panzer W, Klingler H: Herz-Lungen-Wiederbelebung durch Ersthelfer - Einige Ergebnisse und Folgen aus dem Göttinger Pilotprojekt. Anasthesiol Intensivmed Notfallmed Schmerzther. 2001, 36: 573-579. 10.1055/s-2001-17261.CrossRefPubMed

Wenzel V, Russo SG, Arntz HR, Bahr J, Baubin MA, Böttiger BW, Dirks B, Kreimeier U, Fries M, Eich C: Kommentar zu den Leitlinien 2010 zur kardiopulmonalen Reanimation des European Resuscitation Council. Anaesthesist. 2010, 59: 1105-1123. 10.1007/s00101-010-1820-9.CrossRefPubMed

10.

Heuer JF, Barwing J, Eich C, Quintel M, Crozier TA, Roessler M: Initial ventilation through laryngeal tube instead of face mask in out-of-hospital cardiopulmonary arrest is effective and safe. Eur J Emerg Med. 2010, 17: 10-15. 10.1097/MEJ.0b013e32832d852a.CrossRefPubMed

11.

Wiese CH, Semmel T, Müller JU, Bahr J, Ocker H, Graf BM: The use of the laryngeal tube disposable (LT-D) by paramedics during out-of-hospital resuscitation. Resuscitation. 2009, 80: 194-198. 10.1016/j.resuscitation.2008.08.023.CrossRefPubMed

12.

Deakin D, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, Perkins GD: Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support"). Notfall Rettungsmed. 2010, 18: 559-620.CrossRef

13.

Wenzel V, Lindner KH, Prengel AW: Ventilation during cardio-pulmonaryresuscitation (CPR). A literature study and analysis of ventilation strategies. Anaesthesist. 1997, 46: 133-141. 10.1007/s001010050383.CrossRefPubMed

14.

Cuttino M: Management of ventilation during resuscitation. Contemporary cardiology: cardiopulmonary resuscitation. Edited by: Ornato JP, Peberdy MA. Totowa, NJ: Humana Press Inc., S, 95-110.

15.

Bowman FP, Menegazzi JJ, Check BD, Duckett TM: Lower esophageal sphincter pressure during prolonged cardiac arrest and resuscitation. Ann Emerg Med. 1995, 26: 216-219. 10.1016/S0196-0644(95)70154-0.CrossRefPubMed

16.

Piepho T, Thierbach A, Werner C: Supraglottische Beatmungshilfen in der Notfallmedizin. Notfall Rettungsmed. 2005, 123-128.

17.

Schalk B, Byhahn C, Fausel F, Egner A, Oberndörfer D, Walcher F, Latasch L: Out-of-hospital airway management by paramedics and emergency physicians using laryngeal tubes. Resuscitation. 2010, 81: 323-326. 10.1016/j.resuscitation.2009.11.007.CrossRefPubMed

18.

Ruetzler K, Roessler B, Potura L, Priemayr A, Robak O, Schuster E, Frass M: Performance and skill retention of intubation by paramedics using seven different airway devices - A manikin study. Resuscitation. 2011, 82: 593-597. 10.1016/j.resuscitation.2011.01.008.CrossRefPubMed

19.

Schälte G, Stoppe C, Aktas M, Coburn M, Rex S, Schwarz M, Rossaint R, Zoremba N: Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin. Scand J Trauma Resusc Emerg Med. 2011,

20.

Beauchamp G, Phrampus P, Guyette FX: Simulated rescue airway use by laypersons with scripted telephonic instruction. Resuscitation. 2009, 80: 925-929. 10.1016/j.resuscitation.2009.04.030.CrossRefPubMed

21.

Jokela J, Nurmi J, Grenzwuerker HV, Castren M: Laryngeal tube and intubating laryngeal mask insertion in a manikin by first-responder trainees after a short video-clip demonstration. Prehosp Disaster Med. 2009, 24: 63-66.PubMed

22.

Kurola J, Paakkonen H, Kettunen T, Laakso JP, Gorski J, Silfvast T: Feasibility of written instructions in airway management training of laryngealtube. Scand J Trauma Resusc Emerg Med. 2011, 10: 19-56.

23.

Timmermann A, Cremer S, Heuer J, Braun U, Graf BM, Russo SG: Laryngeal mask LMA Supreme. Application by medical personnel inexperienced in airway management. Anaesthesist. 2008, 57: 970-975. 10.1007/s00101-008-1425-8.CrossRefPubMed

24.

Bickenbach J, Schälte G, Beckers S, Fries M, Derwall M, Rossaint R: The intuitive use of laryngeal airway tools by first year medical students. BMC Emerg Med. 2009, 9: 18-23. 10.1186/1471-227X-9-18.PubMedCentralCrossRefPubMed

25.

Fischer H, Hochbrugger E, Fast A, Hager H, Steinlechner B, Koinig H, Eisenburger P, Frantal S, Greif R: Performance of supraglottic airway devices and 12 month skill retention: a randomized controlled study with manikins. Resuscitation. 2011, 82: 326-331. 10.1016/j.resuscitation.2010.11.014.CrossRefPubMed

26.

Howes BW, Wharton NM, Gibbison B, Cook TM: LMA Supreme insertion by novices in manikins and patients. Anaesthesia. 2010, 65: 343-347. 10.1111/j.1365-2044.2010.06262.x.CrossRefPubMed

27.

Coulson A, Brimacombe J, Keller C, Wiseman L, Ingham T, Cheung D, Popwycz L, Hall B: A comparison of the ProSeal and classic laryngeal mask airways for airway management by inexperienced personnel after manikin-only training. Anaesth Intensive Care. 2003, 31: 286-289.PubMed

28.

Yardy N, Hancox D, Strang T: A comparison of two airway aids for emergency use by unskilled personnel. The Combitube and laryngeal mask. Anaesthesia. 1999, 54: 181-183. 10.1046/j.1365-2044.1999.00651.x.CrossRefPubMed

29.

Cook TM, Gatward JJ, Handel J, Hardy R, Thompson C, Srivastava R, Clarke PA: Evaluation of the LMA Supreme in 100 non-paralysed patients. Anaesthesia. 2009, 64: 555-562. 10.1111/j.1365-2044.2008.05824.x.CrossRefPubMed

30.

Verghese C, Ramaswamy B: LMA-Supreme - a new single-use LMA with gastric access: a report on its clinical efficacy. Br J Anaesth. 2008, 101: 405-410. 10.1093/bja/aen174.CrossRefPubMed

31.

Rai MR, Popat MT: Evaluation of airway equipment: man or manikin?. Anaesthesia. 2011, 66 (1): 1-3. 10.1111/j.1365-2044.2010.06567.x.CrossRefPubMed

32.

LMA International, Laryngeal Mask Company Ldt: LMA Supreme Instructions for Use. 2010, [http://www.lmaco.com/pwpcontrol.php?pwpID=5108]

33.

Noor Zairul M, Khairul Faizi A: Comparison of the VBM laryngeal tube and laryngeal mask airway for ventilation during manual in-line neck stabilisation. Singapore Med J. 2006, 47: 892-896.PubMed

34.

Intersurgical Ltd: i-Gel - Supraglottic Airway Device with Non-inflatable Cuff. 2010, [http://www.i-gel.com/]

35.

Castle N, Owen R, Hann M, Naidoo R, Reeves D: Assessment of the speed and ease of insertion of three supraglottic airway devices by paramedics: a manikin study. Emerg Med J. 2010, 27: 860-863. 10.1136/emj.2009.084343.CrossRefPubMed

36.

Wharton NM, Gibbison B, Gabbott DA, Haslam GM, Muchatuta N, Cook TM: I-gel insertion by novices in manikins and patients. Anaesthesia. 2008, 63: 991-995. 10.1111/j.1365-2044.2008.05542.x.CrossRefPubMed

37.

Chew EE, Hashim NH, Wang CY: Randomised comparison of the LMA Supreme with the I-Gel in spontaneously breathing anaesthetised adult patients. Anaesth Intensive Care. 2010, 38: 1018-1022.PubMed

38.

Jackson KM, Cook TM: Evaluation of four airway training mainikins as patient simulators for the insertion of eight types of supraglottic airway devices. Anaesthesia. 2007, 62: 388-393. 10.1111/j.1365-2044.2007.04983.x.CrossRefPubMed

39.

Devitt JH, Kurrek MM, Cohen MM, Cleave-Hogg D: The validity of performance assessments using simulation. Anesthesiology. 2001, 95: 36-42. 10.1097/00000542-200107000-00011.CrossRefPubMed

40.

Okazaki Y, Kusunoki S, Kawamoto M: Out-of-hospital tracheal intubation practice by advanced level ambulance crews and reeducation program for skill retention: survey of emergency life saving technicians. Masui. 2011, 60: 757-762.PubMed

41.

Arbon P, Hayes J, Woodman R: First aid and harm minimization for victims of road trauma: a population study. Prehosp Disaster Med. 2011, 26: 276-282. 10.1017/S1049023X11006522.CrossRefPubMed

Title: Does a 4 diagram manual enable laypersons to operate the laryngeal mask supreme®? A pilot study in the manikin
Authors: Gereon Schälte
Christian Stoppe
Rolf Rossaint
Laura Gilles
Maike Heuser
Steffen Rex
Mark Coburn
Norbert Zoremba
Annette Rieg
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2012
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/1757-7241-20-21

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Does a 4 diagram manual enable laypersons to operate the laryngeal mask supreme^®? A pilot study in the manikin

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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