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Comparison of Jaw-Thrust Maneuver and Standard Method for Airway Management with Laryngeal Mask Airway by Paramedics during Chest Compression: A Randomized, Crossover, Manikin Study

Published online by Cambridge University Press:  19 April 2022

Asim E. Ozbek Open the ORCID record for Asim E. Ozbek [Opens in a new window]  and
Emre Sanci Open the ORCID record for Emre Sanci [Opens in a new window]
Asim E. Ozbek*
Affiliation:
University of Health Sciences Kocaeli Derince Training and Research Hospital, Department of Emergency Medicine, Kocaeli, Turkey
Emre Sanci
Affiliation:
University of Health Sciences Kocaeli Derince Training and Research Hospital, Department of Emergency Medicine, Kocaeli, Turkey
*
Correspondence: Asim Enes Ozbek, MD University of Health Sciences Kocaeli Derince Training and Research Hospital Department of Emergency Medicine 41900, Derince, Kocaeli, Turkey E-mail: [email protected]
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Abstract

Introduction:

The first priority of the primary survey of trauma care is airway management. For patients who have a known or suspected cervical spine injury, using the jaw-thrust maneuver is critical. It was hypothesized that the jaw-thrust maneuver would ease the insertion of the laryngeal mask airway (LMA) by moving the tongue forward from the palate and posterior pharyngeal wall.

Study Objectives:

The aim of the study was to evaluate the effect of jaw-thrust maneuver on LMA insertion times of the paramedics with or without chest compression and with or without cervical stabilization in a manikin.

Methods:

Eleven experienced paramedics inserted LMA in jaw-thrust position and standard position in chest compression without cervical stabilization scenario, chest compression with cervical stabilization scenario, cervical stabilization without chest compression scenario, and the scenario where neither cervical stabilization nor chest compression were performed. The primary outcome of the study was the comparison of LMA insertion times for each method. The secondary outcome measures were first-pass success rates and the comparison of the difficulty level of each method.

Results:

During the LMA placement, performing the jaw-thrust maneuver instead of the standard method did not shorten the LMA insertion times. Adding chest compression and/or cervical stabilization did not complicate the LMA insertion. All of the LMA insertion attempts during the jaw-thrust maneuver and standard method were successful.

Conclusion:

The findings of this study suggest that LMA insertion might be attempted both during the jaw-thrust maneuver and standard position in patients with or without chest compression and with or without cervical stabilization.

Keywords

airwaycardiopulmonary resuscitationlaryngeal mask airwaytrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 3 , June 2022 , pp. 378 - 382
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Carney, N, Totten, AM, Cheney, T, et al. Prehospital airway management: a systematic review. Prehosp Emerg Care. 2021. Epub ahead of print.CrossRefGoogle Scholar
Zwingmann, J, Mehlhorn, AT, Hammer, T, Bayer, J, Südkamp, NP, Strohm, PC. Survival and neurologic outcome after traumatic out-of-hospital cardiopulmonary arrest in a pediatric and adult population: a systematic review. Crit Care. 2012;16(4):R117.CrossRefGoogle Scholar
Newgard, CD, Schmicker, RH, Hedges, JR, et al. Emergency medical services intervals and survival in trauma: assessment of the “golden hour” in a North American prospective cohort. Ann Emerg Med. 2010;55(3):235–246.CrossRefGoogle Scholar
Boidin, MP. Airway patency in the unconscious patient. Br J Anaesth. 1985;57(3):306–310.CrossRefGoogle ScholarPubMed
Nandi, PR, Charlesworth, CH, Taylor, SJ, Nunn, JF, Doré, CJ. Effect of general anesthesia on the pharynx. Br J Anaesth. 1991;66(2):157–162.CrossRefGoogle ScholarPubMed
Sung, A, Kalstein, A, Radhakrishnan, P, Yarmush, J, Raoof, S. Laryngeal mask airway: use and clinical applications. J Bronchology Interv Pulmonol. 2007;14:181–188.Google Scholar
Panchal, AR, Bartos, JA, Cabañas, JG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_suppl_2):S366–S468.CrossRefGoogle ScholarPubMed
American College of Surgeons, Committee on Trauma. Advanced Trauma Life Support: Student Course Manual. Tenth edition. Chicago, Illinois USA: American College of Surgeons; 2018.Google Scholar
Wang, HE, Schmicker, RH, Daya, MR, et al. Effect of a strategy of initial laryngeal tube insertion vs endotracheal intubation on 72-hour survival in adults with out-of-hospital cardiac arrest. JAMA. 2018;320(8):769–778.CrossRefGoogle ScholarPubMed
Pollack, CV. The laryngeal mask airway: a comprehensive review for the emergency physician. J Emerg Med. 2001;20(1):53–66.CrossRefGoogle ScholarPubMed
Wang, J, Shi, X, Xu, T, Wang, G. Predictive risk factors of failed laryngeal mask airway insertion at first attempt. J Int Med Res. 2018;46(5):1973–1981.CrossRefGoogle ScholarPubMed
Jeon, YT, Na, HS, Park, SH, et al. Insertion of the ProSeal laryngeal mask airway is more successful with the 90° rotation technique. Can J Anesth. 2010;57(3):211–215.CrossRefGoogle ScholarPubMed
Brimacombe, J, White, A, Berry, A. Effect of cricoid pressure on ease of insertion of the laryngeal mask airway. Br J Anaesth. 1993;71(6):800–802.CrossRefGoogle ScholarPubMed
Ansermino, JM, Blogg, CE. Cricoid pressure may prevent insertion of the laryngeal mask airway. Br J Anaesth. 1992;69(5):465–467.CrossRefGoogle ScholarPubMed
Aoyama, K, Takenaka, I, Sata, T, Shigematsu, A. The triple airway maneuver for insertion of the laryngeal mask airway in paralyzed patients. Can J Anaesth. 1995;42(11):1010–1016.CrossRefGoogle Scholar
Maruyama, K, Tsukamoto, S, Ohno, S, et al. Effect of cardiopulmonary resuscitation on intubation using a Macintosh laryngoscope, the AirWay Scope, and the gum elastic bougie: a manikin study. Resuscitation. 2010;81(8):1014–1018.CrossRefGoogle ScholarPubMed
Apfelbaum, JL, Hagberg, CA, Connis, RT, et al. 2022 American society of anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022;136(1):31–81.CrossRefGoogle ScholarPubMed
Akkuş İlkay, B, Kavak Akelma, F, Emlek, M, Özkan, D, Ergil, J, Polat, R. Comparison of the standard and triple airway maneuvering techniques for i-gel placement in patients undergoing elective surgery: a randomized controlled study. J Anesth. 2020;34(4):512.CrossRefGoogle Scholar
Komasawa, N, Ueki, R, Yamamoto, N, et al. Comparison of air-Q and Soft Seal laryngeal mask for airway management by novice doctors during infant chest compression: a manikin study. Resuscitation. 2012;83(3):365–368.CrossRefGoogle ScholarPubMed
Chloros, T, Xanthos, T, Iacovidou, N, Bassiakou, E. Supreme laryngeal mask airway achieves faster insertion times than classic LMA during chest compressions in manikins. Am J Emerg Med. 2014;32(2):156–159.CrossRefGoogle ScholarPubMed
Kohama, H, Komasawa, N, Ueki, R, et al. Comparison of Supreme and Soft Seal laryngeal masks for airway management during cardiopulmonary resuscitation in novice doctors: a manikin study. J Anesth. 2011;25(1):98.CrossRefGoogle ScholarPubMed
Lee, DW, Kang, MJ, Kim, YH, et al. Performance of intubation with 4 different airway devices by unskilled rescuers: manikin study. Am J Emerg Med. 2015;33(5):691–696.CrossRefGoogle ScholarPubMed
Bielski, A, Smereka, J, Madziala, M, Golik, D, Szarpak, L. Comparison of blind intubation with different supraglottic airway devices by inexperienced physicians in several airway scenarios: a manikin study. Eur J Pediatr. 2019;178(6):871.CrossRefGoogle ScholarPubMed
Asai, T, Neil, J, Stacey, M. Ease of placement of the laryngeal mask during manual in-line neck stabilization. Br J Anaesth. 1998;80(5):617–620.CrossRefGoogle ScholarPubMed