Bag-mask ventilation and direct laryngoscopy versus intubating laryngeal mask airway: a manikin study of hands-on times during cardiopulmonary resuscitation

Abstract

Objectives The percentage of hands-on time during cardiopulmonary resuscitation is a major determinant of patient outcome. We hypothesized that airway management with the intubating laryngeal mask airway (ILMA) would give greater hands-on time than with bag-mask ventilation (BMV), followed by direct laryngoscopy (DL), particularly in difficult-to-manage airways. Participants and methods Thirty paramedics and 40 medical students performed four standardized, 6-min cardiopulmonary resuscitation scenarios with the SimMan3G in a random sequence. These were normal and difficult-to-manage airways using either BMV+DL or ILMA. Results The time to the first successful ventilation was significantly longer with the ILMA (P < 0.001). Hands-on time was lower for the ILMA after 2 min (67 +/- 8 vs. 81 +/- 8 s for BMV+DL, P < 0.001), but was then significantly greater from the third minute onward (115 +/- 11 vs. 104 +/- 9 s for BMV+DL, P < 0.001). The success rate of the first intubation attempt was higher and the time to ET placement was shorter with the ILMA, especially in the difficult-to-manage airway (P < 0.001). Conclusion In this manikin-based study, hands-on time was greater with the ILMA than with BMV+DL. The ILMA was particularly useful in increasing hands-on times in the difficult-to-manage airway.