Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of out of hospital cardiac arrest: A feasibility study

Benger, J.; Coates, D.; Davies, S.; Greenwood, R.; Nolan, J.; Rhys, M.; Thomas, M.; Voss, S.

Abstract

© 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. Background: The best initial approach to advanced airway management during out of hospital cardiac arrest (OHCA) is unknown. The traditional role of tracheal intubation has been challenged by the introduction of supraglottic airway devices (SGAs), but there is contradictory evidence from observational studies. We assessed the feasibility of a cluster-randomized trial to compare the i-gel SGA vs the laryngeal mask airway supreme (LMAS) vs current practice during OHCA. Methods: We conducted a cluster-randomized trial in a single ambulance service in England, with individual paramedics as the unit of randomization. Consenting paramedics were randomized to use either the i-gel or the LMAS or usual practice for all patients with non-traumatic adult OHCA, that they attended over a 12-month period. The primary outcome was study feasibility, including paramedic and patient recruitment and protocol adherence. Secondary outcomes included survival to hospital discharge and 90 days. Results: Of the 535 paramedics approached, 184 consented and 171 attended study training. Each paramedic attended between 0 and 11 patients (median 3; interquartile range 2-5). We recruited 615 patients at a constant rate, although the LMAS arm was suspended in the final two months following three adverse incidents. The study protocol was adhered to in 80% of patients. Patient characteristics were similar in the three study arms, and there were no differences in secondary outcomes. Conclusions: We have shown that a prospective trial of alternative airway management strategies in OHCA, cluster randomized by paramedic, is feasible.

Citation

Benger, J., Coates, D., Davies, S., Greenwood, R., Nolan, J., Rhys, M., …Voss, S. (2016). Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of out of hospital cardiac arrest: A feasibility study. British Journal of Anaesthesia, 116(2), 262-268. https://doi.org/10.1093/bja/aev477

• Journal Article Type: Article
• Acceptance Date: Dec 7, 2015
• Publication Date: Feb 1, 2016
• Deposit Date: Jan 27, 2016
• Publicly Available Date: Jan 27, 2017
• Journal: British Journal of Anaesthesia
• Print ISSN: 0007-0912
• Electronic ISSN: 1471-6771
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 116
• Issue: 2
• Pages: 262-268
• DOI: https://doi.org/10.1093/bja/aev477
• Keywords: cardiopulmonary resuscitation, heart arrest, mortality, resuscitation
• Public URL: https://uwe-repository.worktribe.com/output/915088
• Publisher URL: http://dx.doi.org/10.1093/bja/aev477
• Additional Information: Additional Information : This is a pre-copyedited, author-produced PDF of an article accepted for publication in British Journal of Anaesthesia following peer review. The version of record Benger, J. and Voss, S. (2016) Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of out of hospital cardiac arrest: A feasibility study. British Journal of Anaesthesia, 116 (2). pp. 262-268 is available online at: http://dx.doi.org/10.1093/bja/aev477