Which is more effective for ventilation in the prehospital setting during cardiopulmonary resuscitation, the laryngeal mask airway or the bag-valve-mask?

From the Journal of Emergency Primary Health Care:

Prehospital care providers are responsible for providing adequate ventilation during cardiopulmonary resuscitation (CPR). Endotracheal intubation (ETI) is widely accepted as the ‘gold standard’ for airway protection and the preferred method for ventilation. However, most Australian paramedics are not trained to perform ETI. Laryngeal Mask Airway (LMA) and Bag-Valve-Mask (BVM) are seen as adequate alternatives to ETI as recommended by the International Liaison Committee of Resuscitation (ILCOR). The objective of this study was to identify which airway device LMA or BVM (with OPA/NPA) is more effective in airway patency and ventilation during cardiopulmonary resuscitation in the prehospital environment.

Method A literature search was conducted using medical electronic databases, MEDLINE CINHAL, EMBASE, Meditext, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus. These databases were searched from January 1996 until the end of January 2010. Articles were included if the principal objective was to compare ventilation efficiency of the LMA against the BVM in the prehospital setting. References from articles retrieved were reviewed.

Results There were 2937 articles located by the search. Of these, 30 articles met the inclusion criteria with twelve relevant to the prehospital environment. In the twelve prehospital studies, two involved the use of mannequins, four were retrospective, five were observational, and there was one a literature review.

Conclusion The findings from this review suggest that the LMA is more effective at ventilations over time during CPR in adults, as there is less risk of gastric regurgitation and pulmonary aspiration. The BVM is quicker at performing the first ventilation but there is a loss of effectiveness over time. BVM is considered the best method for ventilating children and neonates.

 

 

California Principal Blocked Ambulance From Injured Player

From JEMS:

Del Mar High School’s principal is under fire after blocking an ambulance from driving onto the school’s track to reach a 14-year-old running back who suffered a concussion during a football game.

Emergency workers had to haul a gurney 75 yards down field to where Keanu Gallardo lay after suffering a blow to his neck and helmet near the end of Del Mar’s frosh-soph game on Oct. 29.