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Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of out of hospital cardiac arrest : a feasibility study

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Benger, J., Coates, D., Davies, S., Greenwood, R., Nolan, Jerry P., Rhys, M., Thomas, M. and Voss, S. (2016) Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of out of hospital cardiac arrest : a feasibility study. British Journal of Anaesthesia, 116 (2). pp. 262-268. doi:10.1093/bja/aev477 ISSN 0007-0912.

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Official URL: http://dx.doi.org/10.1093/bja/aev477

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Abstract

Background

The best initial approach to advanced airway management during out of hospital cardiac arrest (OHCA) is unknown. The traditional role of tracheal intubation has been challenged by the introduction of supraglottic airway devices (SGAs), but there is contradictory evidence from observational studies. We assessed the feasibility of a cluster-randomized trial to compare the i-gel SGA vs the laryngeal mask airway supreme (LMAS) vs current practice during OHCA.

Methods

We conducted a cluster-randomized trial in a single ambulance service in England, with individual paramedics as the unit of randomization. Consenting paramedics were randomized to use either the i-gel or the LMAS or usual practice for all patients with non-traumatic adult OHCA, that they attended over a 12-month period. The primary outcome was study feasibility, including paramedic and patient recruitment and protocol adherence. Secondary outcomes included survival to hospital discharge and 90 days.

Results

Of the 535 paramedics approached, 184 consented and 171 attended study training. Each paramedic attended between 0 and 11 patients (median 3; interquartile range 2–5). We recruited 615 patients at a constant rate, although the LMAS arm was suspended in the final two months following three adverse incidents. The study protocol was adhered to in 80% of patients. Patient characteristics were similar in the three study arms, and there were no differences in secondary outcomes.

Conclusion

We have shown that a prospective trial of alternative airway management strategies in OHCA, cluster randomized by paramedic, is feasible.

Clinical trial registration

Registered on the International Standard Randomised Controlled Trial Registry (ISRCTN: 18528625)

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Cardiac arrest -- Treatment, Trachea -- Intubation, Breathing apparatus
Journal or Publication Title: British Journal of Anaesthesia
Publisher: Oxford University Press
ISSN: 0007-0912
Official Date: February 2016
Dates:
DateEvent
February 2016Published
13 December 2017Available
7 December 2015Accepted
Volume: 116
Number: 2
Page Range: pp. 262-268
DOI: 10.1093/bja/aev477
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
Date of first compliant deposit: 6 February 2019
Date of first compliant Open Access: 7 February 2019
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
PB-PG-0110-20288[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272

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