Poster Presentation from IMSH 2010 discussing a study that evaluated paramedics\' ability to complete LMA assisted Intubation.

1. Simulation-based training to teach paramedics how to place
through and intubate single-use LMA-FastrachTM
1
Bauman E, 1Joffe AM, 2Liew EC, 1Seider S
1
University of Wisconsin, School of Medicine and Public Health;
2
University of Southern California
introduction The time required for iLMA insertion (T1), for tracheal intubation on the second, and one (2%) on the third. Intubation time was 33+7.8
through the iLMA (T2), and the total time from picking up the iLMA seconds. The total time to complete iLMA and endotracheal tube
Local paramedics are following a new protocol utilizing the single-
to confirmed tracheal intubation (T3) was recorded. Prior to attempted placement was 72+17 seconds. No differences were found between
use LMA-FastrachTM (iLMA) as the primary airway rescue device.
intubation, the view of the vocal cords through the iLMA was graded gender, among years of experience, or among type of training.
The departments of Anesthesiology and Emergency Medicine (EM)
using a fiberoptic endoscope as: 1=full view, 2=partial view of the
at the University of Wisconsin separately developed and administered
cords, 3=epiglottis only, or 4=other (LMA, cuff, pharynx, other).
simulation-based educational interventions instructing paramedics
in placement of an iLMA and passage of a tracheal tube through it. Age, gender, years of paramedic experience, previous healthcare
Study objectives included (1) evaluation of training, (2) determining licensure, and type of iLMA training were included in the analysis.
any difference between anesthesia and EM-based training, and (3) Paramedic experience was defined as <3 years, 4-14 years, >15 years.
determining whether prior experience or gender affected success Type of iLMA training was as either anesthesia, EM-based, or both.
rates. Group comparisons were made by Mann-Whitney U or one-way
ANOVA with significance defined by a two-tailed p-value < 0.05. Data
methods is presented as mean+SD and number and percentage. Discussion
Paramedics attempted to place a #3 single-use iLMA into an Our study indicates that paramedics can be taught to insert and
AirsimTM airway management trainer. Blind insertion of a tracheal results intubate effectively through an iLMA using an airway management
tube through the iLMA was then attempted. Consistent with Demographics: 35 participants aged 39+11 years, 26 (74%) male and
simulator regardless of gender or years of prior experience. The clinical
paramedic protocol, removal of the iLMA over the tracheal tube was 9 (26%) female with 8.8+5.6 years of prior paramedic experience. All
discipline of those providing instruction did not affect paramedics’
not attempted. participants had previous experience as an EMT-basic 26(74%) or
ability to correctly use an iLMA. This is consistent with the available
intermediate 9(26%) prior to becoming a paramedic 6.2+6.6.
research on novice use of laryngeal mask airways and supports the
Training: 30 (86%) participants completed iLMA training and continued introduction of the LMA into the pre-hospital environment.
5 (14%) did not. Of those participants who underwent training, 16 Further research should include an examination of paramedics’ success
received anesthesia-based, eight received EM-based training, and 5 rates deploying the LMA in actual patients.
had completed both training interventions.
Task completion: 33 (94%) iLMA insertions were successful on Eric B. Bauman, PhD, RN
Department of Anesthesiology
the first attempt. Two (6%). insertions required a second attempt.
University of Wisconsin School of Medicine and Public Health
Insertion took 38+14 seconds. Thirty-three (94%) of the participants 600 Highland Avenue
Special Thanks to Lindsey Young & Emily Schaeffer Madison, WI 53792
successfully intubated through the iLMA on first attempt, one (2%) ebauman@wisc.edu