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Does a 4 diagram manual enable laypersons to operate the Laryngeal Mask Supreme®? A pilot study in the manikin.

Schälte G, Stoppe C, Rossaint R, Gilles L, Heuser M, Rex S, Coburn M, Zoremba N, Rieg A - Scand J Trauma Resusc Emerg Med (2012)

Bottom Line: A significant reduction in the "no-flow-time", quantitatively better chest compressions and an improved quality of ventilation can be demonstrated during CPR using supraglottic airway devices (SADs).No significant difference related to previous BLS training (P = 0.85), technical education (P = 0.07) or gender could be demonstrated (P = 0.25).Improvements in labeling and the quality of instructional photographs may reduce individual error and may optimize understanding.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, University Hospital Aachen, Aachen, Germany. gschaelte@ukaachen.de

ABSTRACT

Background: Bystander resuscitation plays an important role in lifesaving cardiopulmonary resuscitation (CPR). A significant reduction in the "no-flow-time", quantitatively better chest compressions and an improved quality of ventilation can be demonstrated during CPR using supraglottic airway devices (SADs). Previous studies have demonstrated the ability of inexperienced persons to operate SADs after brief instruction. The aim of this pilot study was to determine whether an instruction manual consisting of four diagrams enables laypersons to operate a Laryngeal Mask Supreme® (LMAS) in the manikin.

Methods: An instruction manual of four illustrations with speech bubbles displaying the correct use of the LMAS was designed. Laypersons were handed a bag containing a LMAS, a bag mask valve device (BMV), a syringe prefilled with air and the instruction sheet, and were asked to perform and ventilate the manikin as displayed. Time to ventilation was recorded and degree of success evaluated.

Results: A total of 150 laypersons took part. Overall 145 participants (96.7%) inserted the LMAS in the manikin in the right direction. The device was inserted inverted or twisted in 13 (8.7%) attempts. Eight (5.3%) individuals recognized this and corrected the position. Within the first 2 minutes 119 (79.3%) applicants were able to insert the LMAS and provide tidal volumes greater than 150 ml (estimated dead space). Time to insertion and first ventilation was 83.2 ± 29 s. No significant difference related to previous BLS training (P = 0.85), technical education (P = 0.07) or gender could be demonstrated (P = 0.25).

Conclusion: In manikin laypersons could insert LMAS in the correct direction after onsite instruction by a simple manual with a high success rate. This indicates some basic procedural understanding and intellectual transfer in principle. Operating errors (n = 91) were frequently not recognized and corrected (n = 77). Improvements in labeling and the quality of instructional photographs may reduce individual error and may optimize understanding.

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Number and origin of errors and individual correction. Data are numbers.
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Figure 3: Number and origin of errors and individual correction. Data are numbers.

Mentions: Data from 150 participants (121 male, 29 female) were analyzed. Mean age was 22.9 years (22.9 ± 2.8). Overall 145 participants (96.7%) inserted the LMAS in the correct direction in the manikin. Within a 2 min period 119 (79.3%) applicants were able to insert the LMAS and provide tidal volumes greater than 150 ml (approximate dead space). 74% (n = 111) of the participants were able to deliver tidal volumes of greater than 500 ml during these first 2 minutes. The device was inserted inversely or twisted in 13 (8.7%) attempts. 8 (5.3%) individuals recognized and corrected the position. The most common fault was an incorrect depth of insertion (n = 61; 40.7%). 20 applicants successfully corrected the depth to the labeled level. The second most common fault was the tilt of the manikin's head (n = 30; 20%) and this made ventilation impossible in 5 cases. In 21 cases (14%) the problem concerned the cuff, i.e. cuff inflation was insufficient (n = 15) or simply omitted (n = 6). In one trial each, the connection of the BMV (0.67%) or squeezing the BMV were omitted (0.67%) (Figure 3). In total the insertion of the LMAS was performed "correctly" by 82 participants (55%) on the first attempt. Despite an obviously sufficient insertion in 18 (12%) attempts no ventilation could be detected and was associated with forgotten or inadequate cuff inflation in 9 efforts. Overall a total of 91 operating errors of different severity and impact could be identified. Only 14 (15.4%) were corrected. The time from start of insertion to first ventilation was 83.2 ± 29 s.


Does a 4 diagram manual enable laypersons to operate the Laryngeal Mask Supreme®? A pilot study in the manikin.

Schälte G, Stoppe C, Rossaint R, Gilles L, Heuser M, Rex S, Coburn M, Zoremba N, Rieg A - Scand J Trauma Resusc Emerg Med (2012)

Number and origin of errors and individual correction. Data are numbers.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3375204&req=5

Figure 3: Number and origin of errors and individual correction. Data are numbers.
Mentions: Data from 150 participants (121 male, 29 female) were analyzed. Mean age was 22.9 years (22.9 ± 2.8). Overall 145 participants (96.7%) inserted the LMAS in the correct direction in the manikin. Within a 2 min period 119 (79.3%) applicants were able to insert the LMAS and provide tidal volumes greater than 150 ml (approximate dead space). 74% (n = 111) of the participants were able to deliver tidal volumes of greater than 500 ml during these first 2 minutes. The device was inserted inversely or twisted in 13 (8.7%) attempts. 8 (5.3%) individuals recognized and corrected the position. The most common fault was an incorrect depth of insertion (n = 61; 40.7%). 20 applicants successfully corrected the depth to the labeled level. The second most common fault was the tilt of the manikin's head (n = 30; 20%) and this made ventilation impossible in 5 cases. In 21 cases (14%) the problem concerned the cuff, i.e. cuff inflation was insufficient (n = 15) or simply omitted (n = 6). In one trial each, the connection of the BMV (0.67%) or squeezing the BMV were omitted (0.67%) (Figure 3). In total the insertion of the LMAS was performed "correctly" by 82 participants (55%) on the first attempt. Despite an obviously sufficient insertion in 18 (12%) attempts no ventilation could be detected and was associated with forgotten or inadequate cuff inflation in 9 efforts. Overall a total of 91 operating errors of different severity and impact could be identified. Only 14 (15.4%) were corrected. The time from start of insertion to first ventilation was 83.2 ± 29 s.

Bottom Line: A significant reduction in the "no-flow-time", quantitatively better chest compressions and an improved quality of ventilation can be demonstrated during CPR using supraglottic airway devices (SADs).No significant difference related to previous BLS training (P = 0.85), technical education (P = 0.07) or gender could be demonstrated (P = 0.25).Improvements in labeling and the quality of instructional photographs may reduce individual error and may optimize understanding.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, University Hospital Aachen, Aachen, Germany. gschaelte@ukaachen.de

ABSTRACT

Background: Bystander resuscitation plays an important role in lifesaving cardiopulmonary resuscitation (CPR). A significant reduction in the "no-flow-time", quantitatively better chest compressions and an improved quality of ventilation can be demonstrated during CPR using supraglottic airway devices (SADs). Previous studies have demonstrated the ability of inexperienced persons to operate SADs after brief instruction. The aim of this pilot study was to determine whether an instruction manual consisting of four diagrams enables laypersons to operate a Laryngeal Mask Supreme® (LMAS) in the manikin.

Methods: An instruction manual of four illustrations with speech bubbles displaying the correct use of the LMAS was designed. Laypersons were handed a bag containing a LMAS, a bag mask valve device (BMV), a syringe prefilled with air and the instruction sheet, and were asked to perform and ventilate the manikin as displayed. Time to ventilation was recorded and degree of success evaluated.

Results: A total of 150 laypersons took part. Overall 145 participants (96.7%) inserted the LMAS in the manikin in the right direction. The device was inserted inverted or twisted in 13 (8.7%) attempts. Eight (5.3%) individuals recognized this and corrected the position. Within the first 2 minutes 119 (79.3%) applicants were able to insert the LMAS and provide tidal volumes greater than 150 ml (estimated dead space). Time to insertion and first ventilation was 83.2 ± 29 s. No significant difference related to previous BLS training (P = 0.85), technical education (P = 0.07) or gender could be demonstrated (P = 0.25).

Conclusion: In manikin laypersons could insert LMAS in the correct direction after onsite instruction by a simple manual with a high success rate. This indicates some basic procedural understanding and intellectual transfer in principle. Operating errors (n = 91) were frequently not recognized and corrected (n = 77). Improvements in labeling and the quality of instructional photographs may reduce individual error and may optimize understanding.

Show MeSH
Related in: MedlinePlus