Feasibility of laryngeal mask airway use by prehospital personnel in simulated pediatric respiratory arrest.

INTRODUCTION: Pediatric respiratory arrest is a technically challenging scenario infrequently faced by prehospital providers. Prehospital endotracheal intubation (ETI) is a complex procedure, and one study showed that it may result in worse neurological outcome in these patients. Alternatives to ETI include bag-valve-mask (BVM) ventilation and the laryngeal mask airway (LMA). Although the LMA has been used successfully for pediatric resuscitation in the hospital setting, there is no data describing its use in the prehospital setting. HYPOTHESIS: Prehospital providers can successfully place and ventilate the pediatric LMA in a simulated pediatric respiratory arrest. METHODS: Paramedic students received a 1-hour training session covering the use of the pediatric LMA. Subjects performed airway management of a simulator 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 4 seconds (IQR 3, 5), and the median for 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 (37 ventilations per minute [IQR 31, 39]) groups. CONCLUSIONS: Prehospital providers were able to place and ventilate a simulated pediatric respiratory arrest patient using the LMA after a brief educational intervention. Obvious air leakage was noted when ventilating with the LMA and likely represents one technical limitation of using a simulator.

Comparison of 1- versus 2-person bag-valve-mask techniques for manikin ventilation of infants and children.

STUDY OBJECTIVE: We compare the mean tidal volumes per weight and peak pressures generated by the 1- and 2-person techniques of bag-valve-mask ventilation in a pediatric model. METHODS: This was a prospective, descriptive study in which postgraduate year 1, postgraduate year 2, and postgraduate year 3 pediatric residents, postgraduate year 2 emergency medicine residents, pediatric emergency department nurses, transport personnel, and paramedics were asked to perform 1- and 2-person bag-valve-mask ventilation on infant and child manikins. Participants were randomly assigned a partner and performed both techniques. Tidal volume and peak pressure were recorded every 15 seconds for 3 minutes by a blinded assistant. RESULTS: Seventy participants, 10 in each group, completed the study. Overall, for the infant- and child-manikin groups, the 2-person technique generated higher mean tidal volume per weight than the 1-person technique (infant: 7.2 versus 5.9; child: 8.8 versus 6.1). Overall, the 2-person technique generated higher mean peak pressures than the 1-person technique (infant: 27.4 versus 22.0; child: 27.2 versus 21.8). Similar results were found among all provider groups. Paramedics were the only providers able to generate a recommended median tidal volume per weight of 10 mL/kg in the child manikin group when using either technique and were the only providers, when using the 2-person technique, to generate a mean tidal volume per weight of 10 mL/kg in the infant group. CONCLUSION: Two-person bag-valve-mask ventilation provided greater mean tidal volumes per weight and peak pressures in the infant- and child-manikin model compared with the 1-person technique.