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

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 combitude proved to be valid alternatives for the bag-valve-facemask in this experimental model.