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Supraglottic, non-invasive airway management device


Supraglottic, non-invasive airway management device Comprised of three main components Airway Tube Mask Inflation line Mask designed to conform to the contours of the ... – PowerPoint PPT presentation

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Title: Supraglottic, non-invasive airway management device

(No Transcript)
What is an LMA?
  • Supraglottic, non-invasive airway management
  • Comprised of three main components
  • Airway Tube
  • Mask
  • Inflation line
  • Mask designed to conform to the contours of the
    hypopharynx with its lumen facing the laryngeal
  • Designed to maintain/temporize an airway in
  • Patients with immediate need of an airway
  • Patients with failed tracheal intubation or in
    whom tracheal intubation is not an option
  • Patients in whom the benefit of establishing an
    airway outweighs the risk of regurgitation and/or

LMA Placement
  • When fully inserted using the recommended
    insertion technique, the distal tip of the LMA
    cuff presses against the upper esophageal
  • Its sides face into the pyriform fossae and the
    upper border rests against the base of the tongue

LMA History
  • The Laryngeal Mask Airway (LMA) was invented and
    designed by Dr. A.I.J. Brain in the East End of
    London in 1981. While a practicing
    anesthesiologist, Dr. Brain identified the need
    for better safety, reliability and the ease of
    insertion of airway management devices.
  • Introduced to the U.S. anesthesia market in 1992
    and to the emergency market in 1996
  • Included in and supported by the American Heart
    Association Resuscitation Guidelines
  • Used more than 250 million times worldwide
  • Currently used in 38 of all surgeries
  • Supported by over 2,800 published references and

AHA Guidelines on Ventilation
  • Tracheal intubation should only be attempted by
    experienced providers
  • BLS The LMA is an alternate airway for
    providers not trained in intubation
  • ACLS The LMA is a class IIa device
    acceptable, safe and useful. Standard of care
  • PALS Indeterminate The LMA is a promising
  • Neonatal The LMA is an alternative in cannot
    intubate, cannot ventilate situation

Characteristics LMA Unique LMA Fastrach(Reusable/Single Use) BVM Combitube ETT
Ease of use ? ? ? ?
Non-invasive ? ? ?
Hemodynamic stability upon placement ? When not used with ETT ?
Improved oxygen saturation ? ? ? ?
Avoidance of endobronchial/esophageal intubation ? When not used with ETT ? Accommodates
Can be used without manipulating head neck ? ?
Inserted in any position/limited access ? ?
Designed to protect against aspiration When used with ETT ? ?
Single-handed ventilation ? ? ? ?
Less user fatigue ? ? ? ?
Ease of training ? ? ?
Retention of skill ? ? ? If performing gt6 per year
Latex-free ? ? Requires special purchase ?
Pediatric-Adult sizes ? Large children-adults ? ?
AHA Recommended Airway Devices
LMA Advantages
  • Advantages over the face mask
  • Airway quality generally unaffected by anatomical
    factors (e.g., edentulous, bearded, southern
    Asian, neonatal patients) or by facial damage
  • Provides clearer airway
  • Airtight seal more easily obtained
  • Compression of eyeballs and face avoided
  • Higher concentration of inspired oxygen
  • Lower incidence of gastric insufflation,
    regurgitation and aspiration in CPR studies
  • Protects against aspiration of blood from nasal
    and oral cavities
  • Less manipulation of head and neck required in
    those with suspected cervical spine injuries
  • One hand is free for other important tasks

LMA Advantages
  • Advantages over the ETT
  • Insertion easier to learn
  • Higher levels of skill retention over time
  • Higher first time placement rates
  • Shorter time to achieve an adequate airway
  • Plentiful supply of routine cases on which to
    gain experience
  • Laryngoscopy unnecessary
  • Neuromuscular blockade not required
  • Avoids risk of esophageal and endobronchial
  • Placement easily achieved with MILS of cervical
    spine applied
  • Less invasive of and less traumatic to
    respiratory tract
  • Lower incidence of laryngospasm and bacteraemia
  • Reduced risk of pulmonary barotrauma

  • (Katz SH, Falk JL. Misplaced endotracheal tubes
    by paramedics in an urban emergency medical
    services system. Ann Emerg Med. January
    20013732-37. )
  • Prospective observational study of patients
    intubated in the field by paramedics in order to
    determine the incidence of unrecognised misplaced
    endotracheal tubes (ETTs) in a large urban,
    decentralised EMS system ? On arrival at
    hospital, ETT position was assessed by an
    emergency physician using a combination of
    auscultation, end-tidal carbon dioxide (EtCO2)
    monitoring, and direct laryngoscopy
  • 27/108 (25) of patients had improperly placed
    endotracheal tubes ? 18/27 (67) of misplaced
    tubes were in the oesophagus and 10/18 (56) of
    these patients died in the ED
  • 9/27 (33) had the tip of the tube in the
    hypopharynx above the vocal cords and 3 (33) of
    these patients died in the ED.
  • Ann Emerg Med 2001

  • (Verghese C, Prior-Willeard PF, Baskett PJ.
    Immediate management of the airway during
    cardiopulmonary resuscitation in a hospital
    without a resident anaesthesiologist. Eur J Emerg
    Med. 1994 Sep1(3)123-5)
  • When the resident anaesthetist was withdrawn from
    the CPR team in a 407-bed UK hospital, nurses
    having been trained to use the LMA for the
    initial management of the airway in CPR
  • ? Use of the LMA increased from 2 to 64 cases
  • ? Use of the endotracheal tube decreased from
    57 to 20 cases
  • Return of spontaneous circulation increased
    from 36 to 61 of cases
  • There were no instances of failure to
    maintain the immediate airway
  • (during the first year when compared with the
    previous 12 months)
  • Eur J Emerg Med 1994

SELECTED REFERENCE (4) (Deakin CD, Peters R,
Tomlinson P, Cassidy M. Securing the prehospital
airway a conparison of laryngeal mask insertion
and endotracheal intubation by UK paramedics.
Emerg Med J 20052264-67) Paramedics with the
Hampshire Ambulance Service trained in the use of
the LMA and ETT were asked to secure the airway
in patients undergoing routine anaesthesia ?
Even under optimal conditions, 30 of attempts at
tracheal intubation by paramedics were
unsuccessful ? Laryngeal mask insertion was
successful in 80 of patients in whom
endotracheal intubation had failed The authors
concluded that a disposable laryngeal mask has a
higher success rate in securing the airway and,
overall, secures the airway more reliably than
endotracheal intubation Emerg Med J 2005
Patients die from
Failure to Ventilate Failure to Oxygenate
Not from Failure to Intubate
LMA Advantages
  • Advantages over the Combitube
  • Latex-free
  • Cost-effective
  • Less invasive of and less traumatic to
    respiratory tract
  • Less manipulation of head and neck required in
    those with suspected cervical spine injuries
  • Does not require removal for tracheal intubation
  • Ventilation and oxygenation can remain

LMA Fastrach Single Use Ideal for Pre-hospital
  • Rescue device for ACLS/air emergency units in
    failed/difficult intubation
  • Single use
  • Temporizing device, functions as alternative to

LMA Fastrach Single Use Size Chart
Mask Size Patient Size LMA Fastrach Single Use
Size 3 Children 30 50 kg X
Size 4 Adults 50 70 kg X
Size 5 Adults 70 100 kg X
LMA Fastrach Single Use
  • Simple, fast insertion technique to achieve
  • Success rate is virtually 100 for establishing
    an airway
  • Allows ventilation between intubation attempts
  • High intubation success rate both blind and
    fiberoptic assisted
  • Supplied ready to use including syringe and
  • Single-handed insertion from any position without
    moving head and neck
  • No need to place fingers in the mouth
  • Comes with wire-reinforced LMA Fastrach Single
    Use Endotracheal Tube and Stabilizer Rod

LMA Fastrach Single Use
  • Rigid, anatomically curved airway tube that is
    wide enough to accept an 8.0 mm cuffed ETT and is
    short enough to ensure passage of the ETT cuff
    beyond the vocal cords
  • Rigid handle to facilitate one-handed insertion,
    removal, and adjustment of the device's position
    and can be pressed anteriorly to increase seal
    pressure during unexpected regurgitation
  • Epiglottic elevating bar in the mask aperture
    which elevates the epiglottis as the ETT is
    passed through and a ramp which directs the tube
    centrally and anteriorly to reduce the risk of
    arytenoid trauma or esophageal placement

LMA Fastrach Success Rate
  • Successful intubation in a variety of difficult
    airway scenarios, including awake intubation, has
    been described by G. Caponas, with the overall
    success rate being approximately 98
  • G Caponas. Intubating Laryngeal Mask Airway.
    Anaesthesia and Intensive Care, Vol. 30, No. 5,
    October 2002

Why Use the LMA Fastrach Single Use for Tracheal
  • Allows easy intubation without laryngoscopy
  • Laryngoscope vs. LMA Fastrach
  • Laryngoscope Distortion of the anatomy to align
    axis may not be possible in some patients due to
    anatomy, surgery, radiation or secretions
  • LMA Fastrach Single Use No tissue distortion
    Because it facilitates ventilation between
    intubation attempts, it allows intubation to take
    place unhurriedly with minimal risk of
  • NOTE Although the LMA Fastrach is ideal for
    difficult airway situations, it is strongly
    recommended that the device be used routinely in
    elective, non-difficult airway patients to
    develop competency

Benefits of the LMA Fastrach Single Use in
Emergency Medicine
  • Rescue device for failed or difficult airway
  • Temporizing
  • Able to ventilate patient while preparing for
    definitive airway
  • Alternative to surgical rescue
  • Able to place in any patient position with one
  • Facilitates tracheal intubation
  • Blind insertion
  • No laryngoscopy or fiberoptics needed
  • Excellent adjunct/backup for RSI

The LMA in Emergency Care
  • Cardiac arrest
  • Near drowning
  • Drug overdose (e.g. opiates)
  • Inhalation of smoke or toxic fumes
  • Trauma including patients with serious facial
    or head trauma
  • For rescue ventilation after failed intubation
  • Inability to maintain an airway or oxygenation
    especially where rapid control is essential

LMA Fastrach Single Use Indications
  • Guide for intubation of the trachea
  • Alternative to the face mask for achieving and
    maintaining control of the airway in routine and
    emergency situations, including anticipated or
    unexpected difficult airways
  • Method of establishing a clear airway in the
    profoundly unconscious patient with absent
    glossopharyngeal and laryngeal reflexes

LMA Fastrach Single Use Contraindications and
  • When used alone, does not protect from
    regurgitation and aspiration
  • Risk of regurgitation/aspiration must be weighed
    against the potential benefit of establishing an
  • Intubation through the LMA Fastrach Single Use
    may not be appropriate when esophageal or
    pharyngeal pathology is present

LMA Fastrach Single Use Insertion
  • Place head and neck in neutral position
  • Fully deflate cuff to spoon shape no wrinkles
  • Lubricate posterior mask top and rub lubricant
    over hard palate
  • Curved part of tube in contact with chin

LMA Fastrach Single Use Insertion
  • Mask tip flat against hard palate
  • Swing mask in circular motion, keeping pressure
    against the posterior pharynx
  • Inflate mask to just seal pressure (50
  • Use up/down, right/left movements to find best
    airway position with minimum leak

Intubating through the LMA Fastrach Single Use
  • Do not intubate when esophageal or pharyngeal
    pathology is present
  • Check the ETT cuff prior to use
  • Lubricate the ETT and gently pass the ETT into
    the LMA Fastrach tube, (rotating and moving the
    ETT up and down) to distribute the lubricant

ETT depth marker
LMA Fastrach Single Use Intubation
  • The ETT transverse line corresponds to the point
    at which the ETT is about to enter the mask
  • Use the handle to gently lift the device 2-5 mm
    to increase seal pressure and optimize alignment
    of the axes with the trachea
  • Advance the ETT until intubation is complete
  • Inflate cuff and confirm intubation

Removal of LMA Fastrach Single Use over ETT
  • Ensure oxygenation
  • Remove ETT connector
  • Deflate LMA Fastrach cuff
  • Swing mask out of pharynx, applying counter
    pressure to the ETT with finger
  • Slide the LMA Fastrach over the Stabilizer Rod
    until the mask is clear of the mouth
  • Remove Stabilizer Rod and gently unthread the
    inflation line and pilot balloon of the ETT
  • Replace the ETT connector and reconfirm placement

13 Reasons the LMA Fastrach Single Use is
Suitable for Pre-hospital Use
  • No need for laryngoscopy
  • Head and neck in neutral alignment for insertion
  • Neuromuscular blockade not necessary
  • At least as easy to insert as the standard LMA
  • Can be introduced blindly with one hand from any
  • Rigid handle facilitates insertion, mask
    positioning (optimizing ventilation) and can be
    pressed anteriorly to increase seal pressure
    during unexpected regurgitation
  • Requires an inter-dental gap of only 20mm
  • No need to insert finger in patients mouth
  • Rigid airway tube resists occlusion by biting
  • Suitable as a rescue airway device in its own
  • Facilitates seamless progression to tracheal
  • Permits ventilation between/during intubation
  • Available as a disposable, single use device

LMA in Pre-hospital Summary
  • AHA recommended alternative airway
  • Clinical experience with over 2,800 clinical
    references which document efficacy and safety
  • The LMA has many advantages as an alternative
    airway including ease of insertion, ease of
    training, less invasive/traumatic, cost-effective
    and effective ventilation

Further Information
  • For further information regarding the LMA
    Fastrach Single Use, including instruction
    manuals, insertion guide and tip sheet, please
    visit or call 1-800-788-7999