Anesthésie et recherche clinique
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Following On-site Instructions for Operating Laryngeal Mask Supreme™ and Laryngeal Tube™ as an Alternative to Mouth-to-Mouth Ventilation in Layperson CPR: A Randomized Trial in the Manikin

Gereon Schälte, Christian Stoppe, Rolf Rossaint, Maike Heuser, Laura Gilles, Marlon Schwarz, Mark Coburn, Norbert Zoremba and Annette Rieg

Background: “Chest compressions only” resuscitation (CCOR) has been suggested one method of increasing laypersons attendance providing bystander resuscitation, avoiding mouth-to-mouth (MTM) ventilation and improving patients’ outcome. In prolonged CCOR without rescue breaths and a non-cardiac origin, neurological outcome is very much dependent on oxygenation. As an alternative to MTM we investigated laypersons ability to operate supraglottic airway devices (SAD) in the manikin, following illustrated on-site instruction. Methods: Laypersons were handed a bag containing either an LMAS or an LT, a bag-mask-valve device (BMV), a syringe prefilled with air, and an instruction manual consisting of four annotated diagrams displaying the correct use of either the Laryngeal Mask Supreme™ (LMAS) or the Laryngeal Tube™ (LT). They were then asked to perform and ventilate a manikin as displayed. The process was evaluated in quantity and quality. Results: A total of 299 laypersons were enrolled. 145 applicants in the LMAS (96.7%) and 143 in the LT (96%) group inserted the SAD in the right direction. Previous BLS education was not associated with a higher rate of success (LMAS (P=0.85) vs. LT (P=0.63)). The most common error identified was the depth of insertion (LT 40.9% (n=61) vs. LMAS 32.7% (n=49); P=0.18). No significant difference was found with regard to positioning the devices twisted or reversed (LT 4.7% (n=7) vs. LMAS 6% (n=9); P=0.79). Conclusion: In simulated setting laypersons can achieve appropriate skills and understanding for both SADs using a simple instruction manual. Application of SADs may be improved by a better labeling, the quality of the instruction sheet and a reduction in steps required.