List Archives

Tue, 26 Mar 2002 11:15:00 +0100

Rowley,

Things are not that simple. I agree that an LMA is not a safe way of se=
curing the airway, and as far as I remember that thread, nobody has con=
tested that statement. Sometimes, however, you may not be able to secur=
e the airway by the best way available, i.e. an ET tube.What then?
The question whether LMA, Combitube, or surgical airway is superior in =
that situation is still open, because there are no studies available. T=
he choice of technique is made by the people who write the EMS protocol=
s, and this choice is influenced by factors like training, previous exp=
erience, option to use drugs (sedatives, hypnotics, relaxants) to facil=
iate intubation, etc.
To me, it seems that most US-based EMS go for the surgical option; in E=
urope, there seems to be an even split between Combitube and LMA, and t=
he surgical airway is not even included in the protocols.
The only way to make sound recommendations would be to compare the thre=
e options an a multi-center randomized study (however, the logistics of=
 such a study seem to be a major obstacle). Until we have data from suc=
h a study we can discuss our opinions as long as we like, but we will n=
ot come to a conclusion which we all could agree upon.

Best regards

Walter

	-----Urspr=FCngliche Nachricht-----
	Von:	 (Rowley Cottingham) [mailto:rowley@rowleys-host.compulink.co.uk]=

	Gesendet am:	Dienstag, 26. M=E4rz 2002 09:39
	An:	trauma-list
	Cc:	rowley
	Betreff:	RE: LMA

	> There are some things that I really like about this list. One of the=
m=20
	> is the way that it reveals how rigid we can all occasionally be (or =

	> appear to be) in our thinking. Someone recently wrote: 'I have gone =
on=20
	> record before as stating that I would act for the prosecution in any=
=20
	> case where soiling of the lower airway occurred after insertion of a=
=20
	> laryngeal mask after trauma.'
	>=20
	> Apologies if this is taken out of context (I have been away and miss=
ed=20
	> some postings) but I presume this wouldn't be a problem if (1) the L=
MA=20
	> had been used as part of a failed intubation drill, (2) the LMA had =

	> been used by a trained operator with no other means at his/her dispo=
sal=20
	> to maintain the airway (e.g UK ambulance technician with obtunded=20
	> hyoxic patient with facial injury), (3) the LMA was used as a primar=
y=20
	> airway management device in patient with restricted access (e.g. And=
y=20
	> Mason's case report in Resuscitation) ....
	>=20
	> Rod
	>=20
	>=20
	> --
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	>=20
	>=20
	Someone was me. LMA is not a safe way of securing the airway. How do y=
ou wish to contest that=20
	statement?

	Best wishes,

	Rowley Cottingham

	rowley@cix.co.uk
	http://www.emergencyunit.com

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