BJA Advance Access published online on December 24, 2007
British Journal of Anaesthesia, doi:10.1093/bja/aem364
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Effect of chest compressions on the time taken to insert airway devices in a manikin
Department of Anaesthesia, Royal United Hospital, Combe Park, Bath BA1 3NG, UK
* Corresponding author. E-mail: jongatward{at}hotmail.com
Background: Resuscitation guidelines recommend that chest compressions should continue throughout attempts to place airway devices. Few data support the use of the tracheal tube over supraglottic airway devices (SADs) during cardiopulmonary arrest. This study was designed to evaluate the speed with which different airway devices could be placed with and without interrupting chest compressions.
Methods: Forty volunteer doctors regularly involved in cardiopulmonary resuscitation (CPR) were timed inserting four different airway devices [tracheal tube (TT), LMATM Classic (cLMA), LMATM ProSeal (PLMA), and igelTM into a manikin], with and without stopping chest compressions.
Results: Chest compressions delayed the placement of the TT only (3.3 s, P<0.0001). Comparison of the speed of insertion of the different airway devices during CPR enabled ranking of the devices: igel (fastest), PLMA (second), and TT and cLMA (joint slowest). The igel was inserted approximately 50% faster than the other devices. Doctors who had previously inserted more than 50 tracheal tubes were significantly faster at intubating the trachea, but no faster at inserting SADs.
Conclusions: Our results show that continuing chest compressions has a minor effect on time for tracheal intubation and until clear human data are available the recommendation to intubate without interrupting CPR is therefore justified. The PLMA and igel (SADs with a gastric drain tube) were both faster to insert than the cLMA and offer additional benefits. They should be considered for use in CPR.
Keywords: equipment, masks anaesthesia; equipment, models; equipment, tubes tracheal; heart, cardiac massage; heart, resuscitation
Declaration of interest. The igels used in this study were donated free by the manufacturers (Intersurgical, Wokingham, UK). T.M.C. has received payment for lecturing from Intavent Orthofix and the LMA Company, both of which manufacture laryngeal mask airways. J.P.N. was co-author of the European Resuscitation Council Advanced Life Support Guidelines.
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