2.50
Hdl Handle:
http://hdl.handle.net/10755/198357
Title:
Airway Management: LMA vs ETT, a Timed Study
Abstract:
[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Airway Management: LMA vs. ETT, a Timed Study

Purpose: An alternative to endotracheal intubation (ET) is the laryngeal mask airway (LMA). This study will identify the times of ET placement as compared to LMA placement. The result may determine a change in pre-hospital care airway management of cardiopulmonary arrest.

Design: Evidence-based study to determine our current practice in the pre-hospital arena.

Setting: The Mobile Intensive Care Unit (MICU) serves seventeen suburban towns and is staffed by emergency medical technician-paramedics and mobile intensive care nurses. The MICU is hospital-based; the hospital is a non-teaching, 421 bed facility with several off-site patient care areas. MICU coverage is 24/7 in three off-site areas.

Participants/Subjects: The participants in this study were emergency medical technician-paramedics (EMT-P) and mobile intensive care nurses (MICN).

Methods: Thirty MICU staff were randomly chosen and placed into two groups: Group 1 consisted of 15 full time staff and Group 2 consisted of 15 part time staff. The usual airway bag containing all the equipment needed for endotracheal intubation in the field was used for the study. Using a stop clock, the EMT-P or MICN was timed from the beginning of unzipping the bag until the beginning of the first ventilation via bag-valve device. To simulate the most common patient position the Stat Simulator Manikin was supine on the floor. Upon completion of the endotracheal intubation, the airway bag was restocked to include a LMA in original packaging. The timed assessment was repeated in the same manner as above.

Results/Outcomes: The average time for the full time staff (Group 1) to intubate with an ET was 95.7 seconds and the average time to utilize a LMA was 64.4 seconds. The average time for the part time staff (Group 2) to intubate with an ET was 101.7 seconds and the average time to utilize a LMA was 60.2 seconds.
A two tailed t-test was used to determine whether or not there was a difference between the timed skill of intubation between the full time and part time group. For ET intubation, Group 1 was 96 ± 23 and the mean for Group 2 was 102 ± 25 (p = 0.497). Thus, the two groups were comparable. For LMA intubation, the mean for Group 1 was 64 ± 21 and for Group 2 was 60 ± 21 (p = 0.581), which shows that the two groups are comparable.

The data demonstrates a highly significant statistical difference between intubation using an ET tube versus an LMA. Average increase in time for Group 1 to ventilate a patient with an ET is 31.3 seconds compared to LMA. Average increase in time for Group 2 to ventilate a patient with an ET is 41.6 seconds compared to LMA. The average time for the two groups is 36.5 seconds (p <0.00001).

Implications: If after initial cardiopulmonary resuscitation and use of automated external defibrillators there is no return of spontaneous circulation, it would seem reasonable to then utilize the LMA as the initial advanced airway.

Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleAirway Management: LMA vs ETT, a Timed Studyen_GB
dc.identifier.urihttp://hdl.handle.net/10755/198357-
dc.description.abstract[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Airway Management: LMA vs. ETT, a Timed Study<br/><br/>Purpose: An alternative to endotracheal intubation (ET) is the laryngeal mask airway (LMA). This study will identify the times of ET placement as compared to LMA placement. The result may determine a change in pre-hospital care airway management of cardiopulmonary arrest.<br/><br/>Design: Evidence-based study to determine our current practice in the pre-hospital arena. <br/><br/>Setting: The Mobile Intensive Care Unit (MICU) serves seventeen suburban towns and is staffed by emergency medical technician-paramedics and mobile intensive care nurses. The MICU is hospital-based; the hospital is a non-teaching, 421 bed facility with several off-site patient care areas. MICU coverage is 24/7 in three off-site areas.<br/><br/>Participants/Subjects: The participants in this study were emergency medical technician-paramedics (EMT-P) and mobile intensive care nurses (MICN). <br/><br/>Methods: Thirty MICU staff were randomly chosen and placed into two groups: Group 1 consisted of 15 full time staff and Group 2 consisted of 15 part time staff. The usual airway bag containing all the equipment needed for endotracheal intubation in the field was used for the study. Using a stop clock, the EMT-P or MICN was timed from the beginning of unzipping the bag until the beginning of the first ventilation via bag-valve device. To simulate the most common patient position the Stat Simulator Manikin was supine on the floor. Upon completion of the endotracheal intubation, the airway bag was restocked to include a LMA in original packaging. The timed assessment was repeated in the same manner as above.<br/> <br/>Results/Outcomes: The average time for the full time staff (Group 1) to intubate with an ET was 95.7 seconds and the average time to utilize a LMA was 64.4 seconds. The average time for the part time staff (Group 2) to intubate with an ET was 101.7 seconds and the average time to utilize a LMA was 60.2 seconds. <br/>A two tailed t-test was used to determine whether or not there was a difference between the timed skill of intubation between the full time and part time group. For ET intubation, Group 1 was 96 ± 23 and the mean for Group 2 was 102 ± 25 (p = 0.497). Thus, the two groups were comparable. For LMA intubation, the mean for Group 1 was 64 ± 21 and for Group 2 was 60 ± 21 (p = 0.581), which shows that the two groups are comparable.<br/><br/>The data demonstrates a highly significant statistical difference between intubation using an ET tube versus an LMA. Average increase in time for Group 1 to ventilate a patient with an ET is 31.3 seconds compared to LMA. Average increase in time for Group 2 to ventilate a patient with an ET is 41.6 seconds compared to LMA. The average time for the two groups is 36.5 seconds (p <0.00001).<br/><br/>Implications: If after initial cardiopulmonary resuscitation and use of automated external defibrillators there is no return of spontaneous circulation, it would seem reasonable to then utilize the LMA as the initial advanced airway. <br/><br/>en_GB
dc.date.available2011-12-21T12:47:15Z-
dc.date.issued2011-12-21T12:47:15Z-
dc.date.accessioned2011-12-21T12:47:15Z-
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