Clinical evaluation of the use of laryngeal tube versus laryngeal mask airway for out-of-hospital cardiac arrest by paramedics in Singapore.

Jing Jing Chan; Zi Xin Goh; Zhi Xiong Koh; Janice Jie Er Soo; Jes Fergus; Yih Yng NG; John Carson Allen; Marcus Eng Hock Ong

Return

Clinical evaluation of the use of laryngeal tube versus laryngeal mask airway for out-of-hospital cardiac arrest by paramedics in Singapore.

Author: Jing Jing CHAN ¹ ; Zi Xin GOH ² ; Zhi Xiong KOH ¹ ; Janice Jie Er SOO ³ ; Jes FERGUS ⁴ ; Yih Yng NG ⁵ ; John Carson ALLEN ⁶ ; Marcus Eng Hock ONG ¹
Author Information

1. Department of Emergency Medicine, Singapore General Hospital, Singapore.
2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
3. Ministry of Health Holdings, Singapore.
4. Medical Department, Singapore Civil Defence Force, Singapore.
5. Home Team, Ministry of Home Affairs, Singapore.
6. Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
Publication Type:Randomized Controlled Trial
Keywords: OHCA; intubation; laryngeal mask airway; laryngeal tube; prehospital
MeSH: Allied Health Personnel; Humans; Intubation, Intratracheal; Laryngeal Masks; Out-of-Hospital Cardiac Arrest/therapy*; Prospective Studies; Singapore
From:Singapore medical journal 2022;63(3):157-161
CountrySingapore
Language:English
Abstract: INTRODUCTION:It remains unclear which advanced airway device has better placement success and fewer adverse events in out-of-hospital cardiac arrests (OHCAs). This study aimed to evaluate the efficacy of the VBM laryngeal tube (LT) against the laryngeal mask airway (LMA) in OHCAs managed by emergency ambulances in Singapore.
METHODS:This was a real-world, prospective, cluster-randomised crossover study. All OHCA patients above 13 years of age who were suitable for resuscitation were randomised to receive either LT or LMA. The primary outcome was placement success. Per-protocol analysis was performed, and the association between outcomes and airway device group was compared using multivariate binomial logistic regression analysis.
RESULTS:Of 965 patients with OHCAs from March 2016 to January 2018, 905 met the inclusion criteria, of whom 502 (55.5%) were randomised to receive LT while 403 (44.5%) were randomised to receive LMA. Only 174 patients in the LT group actually received the device owing to noncompliance. Placement success rate for LT was lower than for LMA (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31-0.90). Complications were more likely when using LT (OR 2.82,0 95% CI 1.64-4.86). Adjusted OR for prehospital return of spontaneous circulation (ROSC) was similar in both groups. A modified intention-to-treat analysis showed similar outcomes to the per-protocol analysis between the groups.
CONCLUSION:LT was associated with poorer placement success and higher complication rates than LMA. The likelihood of prehospital ROSC was similar between the two groups. Familiarity bias and a low compliance rate to LT were the main limitations of this study.