European Resuscitation Council Guidelines for Resuscitation ... - CPR

18 de 0ctubre de 2010 www.elsuapdetodos.com1320 C.D. Deakin et al. / Resuscitation 81 (2010) 1305–1352Fig. 4.8. Insertion of a laryngeal mask airway.When used by inexperienced personnel, ventilation of the lungsof anaesthetised patients is more efficient and easier with an LMAthan with a bag-mask. 330 When an LMA can be inserted withoutdelay it is preferable to avoid bag-mask ventilation altogether.In comparison with bag-mask ventilation, use of a self-inflatingbag and LMA during cardiac arrest reduces the incidence ofregurgitation. 333 One study showed similar arterial blood gasvalues in patients successfully resuscitated after out-of-hospitalcardiac arrest when either an LMA or bag mask was used. 373In comparison with tracheal intubation, the perceived disadvantagesof the LMA are the increased risk of aspiration and inabilityto provide adequate ventilation in patients with low lung and/orchest-wall compliance. There are no data demonstrating whetheror not it is possible to provide adequate ventilation via an LMA withoutinterruption of chest compressions. The ability to ventilate thelungs adequately while continuing to compress the chest may beone of the main benefits of a tracheal tube. There are remarkablyfew cases of pulmonary aspiration reported in the studies of theLMA during CPR.CombitubeThe Combitube is a double-lumen tube introduced blindly overthe tongue, and provides a route for ventilation whether the tubehas passed into the oesophagus. There are many studies of the Combitubein CPR and successful ventilation was achieved in 79–98%of patients. 371,374–381 Two RCTs of the Combitube versus trachealintubation for out-of-hospital cardiac arrest showed no differencein survival. 380,381 Use of the Combitube is waning and in many partsof the world it is being replaced by other devices such as the LT.Laryngeal tubeFig. 4.9. Laryngeal tube. © 2010 ERC.In a manikin CPR study, use of the LT-D reduced the no-flow timesignificantly in comparison with use of a tracheal tube. 386I-gelThe cuff of the I-gel is made of thermoplastic elastomer gel(styrene ethylene butadene styrene) and does not require inflation;the stem of the I-gel incorporates a bite block and a narrowoesophageal drain tube (Fig. 4.10). It is very easy to insert,requiring only minimal training and a laryngeal seal pressureof 20–24 cm H 2 O can be achieved. 387,388 In two manikin studies,insertion of the I-gel was significantly faster than several otherairway devices. 356,389 The ease of insertion of the I-gel and itsfavourable leak pressure make it theoretically very attractive asa resuscitation airway device for those inexperienced in trachealintubation. Use of the I-gel during cardiac arrest has been reportedbut more data on its use in this setting are awaited. 390,391Other airway devicesProSeal LMAThe ProSeal LMA (PLMA) has been studied extensively in anaesthetisedpatients, but there are no studies of its function andperformance during CPR. It has several attributes that, in theory,make it more suitable than the cLMA for use during CPR:improved seal with the larynx enabling ventilation at higher airwaywww.elsuapdetodos.comThe LT was introduced in 2001 (Fig. 4.9); it is known as the KingLT airway in the United States. In anaesthetised patients, the performanceof the LT is favourable in comparison with the classic LMAand ProSeal LMA. 382,383 After just 2 h of training, nurses successfullyinserted a laryngeal tube and achieved ventilation in 24 of 30(80%) of OHCAs. 384 A disposable version of the laryngeal tube (LT-D) is available and was inserted successfully by paramedics in 92OHCAs (85 on the first attempt and 7 on the second attempt). 385Fig. 4.10. I-gel. © 2010 ERC.