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The usage of Ambu® AuraGain
™ laryngeal
mask airway by the lifeguards
Sir,
We read with a great interest the article
“Which option for ventilation
is optimal for resuscitation performed by nurses? Pilot data
” by Kaminska
et al. [
1
], published in The Journal of the American Journal of Emergency
Medicine. The article raises a vital issue of correct ventilation and
main-taining the airway patency by the less experienced medical personnel.
However, not only medical personnel such as doctors, paramedics or
nurses encounter the situations when they have to provide a breathing
support in patient with respiratory failure. Due to the nature of their
work the lifeguards might need to provide help to a patient with sudden
cardiac arrest caused by drowning. As it is crucial to minimize pauses
dur-ing chest compressions when performdur-ing resuscitation, it seems
reason-able to use the supraglottic airway devices and provide a patient with
continuous chest compressions, rather than performing resuscitation
based on the standard sequence of 30 chest compressions followed by 2
rescue breaths, which are usually performed with a self-expanding bag
with a face mask attached. Second-generation supraglottic airway devices
signi
ficantly improve the comfort of airway protection when compared to
the
first generation of those devices [
2
]. Due to the introduction of a
chan-nel into the devices, which allows us to empty the stomach from excess
air, it is possible to provide chest compressions of higher effectiveness.
Numerous clinical studies and those conducted in simulated environment
indicate that the supraglottic airway devices are easy to use just after a
short training [
3
,
4
]. Furthermore, it is possible to perform
“blind
intuba-tion
” with some of the devices with the usage the device's air channel,
which serves as guide for the endotracheal tube [
5
,
6
]. Obviously we
must remember that after the device is implemented, we need to
auscul-tate the patient to con
firm the correct location of the device, which
ex-cludes the pneumothorax which is potentially reversible cause of
cardiac arrest. In addition, when dealing with patients in whom we
2331 Correspondence / American Journal of Emergency Medicine 36 (2018) 2307–2335suspect the cervical spine injury, lifeguards are trained to stabilize the
cer-vical spine using a cercer-vical collar and a spinal board. Many studies indicate
that in those situations, the effectiveness of endotracheal intubation is
limited and therefore a key direction of research should be researching
for the new methods of maintaining the airway patency [
7
,
8
].
The aim of the study was to assess the lifeguards' skills in
maintain-ing the airway patency when usmaintain-ing the Ambu® AuraGain
™ device.
The study included 30 lifeguards. Participants of the study, similarly to
the other studies [
1
,
8
,
9
], prior to the participation in the study took part in
training in the methods of maintaining the airway patency and ventilation
of a patient with cardiac arrest. During the study, the use of Ambu®
AuraGain
™ laryngeal mask (AMBU A/S, Balleroup, Denmark;
Fig. 1
) was
assessed. The maintenance of airway patency was carried out with the
use of the Adult Airway Management Trainer (Simulaids, Inc., Saugerties,
NY, USA) in two research scenarios: Scenario I
– normal airways; Scenario
II
– with an inserted a cervical collar. During the study, similarly to the
ar-ticle by Kaminska et al. [
1
] we assessed both the time of maintaining the
airway patency of the airways with a use of supraglottic airway device,
as well as the easiness of performing the procedure.
The mean time of maintaining the airway patency with the Ambu®
AuraGain
™ laryngeal mask airway was 15 ± 3 s for normal airways vs.
15.5 ± 4 s for the immobilized cervical spine (p = 0.094). Easiness of
using the supraglottic airway device during the maintenance of airway
patency was measured with a 10-point scale, where
“1” means a very
easy procedure and
“10” a difficult procedure. The participants assessed
the easiness at 3 ± 1.5 points during Scenario I, and 3.5 ± 1 points for
scenario II (p = 0.341).
To sum up the lifeguards after short training are capable of
maintain-ing the airway patency with Ambu® AuraGain
™. Furthermore, the use
of cervical collar does not impact the time of the securing airway
pa-tency when using the studied supraglottic airway device.
Togay Evrin, PhD, MD
Department of Emergency Medicine, UFuK University, Ankara, Turkey
Medical Faculty, Dr Ridvan Ege Education and Research Hospital, Ankara,
Turkey
Fig. 1. The Ambu® AuraGain™ laryngeal mask airway.
Lukasz Iskrzycki, MSc, EMT-P
*
Pawel Gawlowski, MSc, EMT-P
Department of Emergency Medical Service, Wroclaw Medical University,
Wroclaw, Poland
⁎Corresponding author at: Department of Emergency Medical Service,
Wroclaw Medical University, 34 Parkowa Str, 51-616 Wroclaw, Poland.
E-mail address:
ptmk.kontakt@gmail.com
(L. Iskrzycki)
14 April 2018
https://doi.org/10.1016/j.ajem.2018.04.052
References
[1] Kaminska H, Gawel WB, Wieczorek W. Which option for ventilation is optimal for resuscitation performed by nurses? Pilot data. Am. J. Emerg. Med. 2018 Sep;36(9): 1710-1711.
[2] Sip M, Dabrowska A, Prucnal K, Puslecki M, Klosiewicz T. Supraglottic devices— future or everyday life? Disaster Emerg Med J 2017;2(2):74–83.https://doi.org/10.5603/ DEMJ.2017.0015.
[3] SzarpakŁ, Kurowski A, Truszewski Z, Robak O, Frass M. Comparison of 4 supraglotttic de-vices used by paramedics during simulated CPR: a randomized controlled crossover trial. Am J Emerg Med 2015;33(8):1084–8 Aughttps://doi.org/10.1016/j.ajem.2015.04.050. [4] March JA, Tassey TE, Resurreccion NB, Portela RC, Taylor SE. Comparison of the I-Gel
supraglottic and King laryngotracheal airways in a simulated tactical environment. Prehosp Emerg Care 2018 Jan 24:1–5.https://doi.org/10.1080/10903127.2017.1399183. [5] Ladny JR, Bielski K, Szarpak L, Cieciel M, Konski R, Smereka J. Are nurses able to per-form blind intubation? Randomized comparison of I-gel and laryngeal mask airway. Am J Emerg Med 2017;35(5):786–7 Mayhttps://doi.org/10.1016/j.ajem.2016.11.046. [6] Bielski K, Smereka J, Ladny JR, Szarpak L. A comparison of the Macintosh laryngoscope and blind intubation via I-gel in intubating an entrapped patient: a randomized cross-over manikin study. Am J Emerg Med 2017;35(5):787–9 Mayhttps://doi.org/10. 1016/j.ajem.2016.11.048.
[7] Smereka J, Ladny JR, Naylor A, Ruetzler K, Szarpak L. C-MAC compared with direct laryn-goscopy for intubation in patients with cervical spine immobilization: a manikin trial. Am J Emerg Med 2017;35(8):1142–6 Aughttps://doi.org/10.1016/j.ajem.2017.03.030. [8] Szarpak L, Karczewska K, Evrin T, Kurowski A, Czyzewski L. Comparison of intubation
through the McGrath MAC, GlideScope, AirTraq, and Miller laryngoscope by para-medics during child CPR: a randomized crossover manikin trial. Am J Emerg Med 2015;33(7):946–50 Julhttps://doi.org/10.1016/j.ajem.2015.04.017.
[9] Ladny JR, Smereka J, Szarpak L. Comparison of the trachway video intubating stylet and Macintosh laryngoscope for endotracheal intubation. Preliminary data. Am J Emerg Med 2017;35(4):574–5 Aprhttps://doi.org/10.1016/j.ajem.2016.12.015.
