Article Data

  • Views 265
  • Dowloads 11

Original Research

Open Access

Dose pre-hospital laryngeal mask airway use has a survival benefit in non-shockable cardiac arrest?


1,Department of Emergency Medicine Chang Gung Memorial Hospital

DOI: 10.22514/SV91.042014.4 Vol.9,Issue 1,April 2014 pp.27-32

Published: 30 April 2014

*Corresponding Author(s): CHAN-WEI KUO E-mail:


Background. Whether pre-hospital laryngeal mask airway (LMA) use poses a survival benefit and should be approved as routine airway management in non-shockable cardiac arrest is of major concern. The present study examined the effective-ness of LMA, in comparison to other pre-hospital airway management on individuals who have experienced non-shockable cardiac arrest. 

Methods. Adult patients who experienced non-shockable cardiac arrest with activation of the emergency medical service (EMS) made up our study cohort in Taoyuan, Taiwan. The data were abstracted from EMS records and cardiac arrest regi-stration protocols. 

Results. Among the 1912 enrolled patients, most received LMA insertion (72.4%), 108 (5.6%) bag-valve-mask (BVM) venti-lation, 376 (19.7%) high-flow oxygen non-rebreather facemask, and only 44 (2.3%) received endotracheal tube intubation (ETI). With regard to survival to discharge, no significant differences in prevalence were evident among the groups: 2.8% of oxygen facial mask, 1.1% of BVM, 2.1% of LMA, and 4.5% of the ETI group survived to discharge (p = 0.314). In comparison to oxygen facial mask use, different types of airway management remained unassociated with survival to discharge after adjusting for variables by logistic regression analysis (BVM: 95% confidence interval [CI], 0.079 – 1.639 [p = 0.186]; LMA: 95% CI, 0.220–2.487 [p = 0.627]; ETI: 95% CI, 0.325–17.820 [p = 0.390]). The results of Hosmer-Lemeshow goodness-of-fit test of logistic regression model revealed good calibration.

Conclusions. Pre-hospital LMA use was not associated with additional survival to discharge compared with facial oxygen mask, BVM, or ETI following non-shockable cardiac arrest.


emergency medical ser-vice, out-of-hospital cardiac arrest, laryngeal mask airway, ventilation, cardiopulmonary resuscitation

Cite and Share

SHEN-CHE LIN,SHOU-CHIEN HSU,YI-MING WENG,CHING-I KUO,CHIEN-WEI CHENG,CHAN-WEI KUO. Dose pre-hospital laryngeal mask airway use has a survival benefit in non-shockable cardiac arrest?. Signa Vitae. 2014. 9(1);27-32.


1. Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):S729-67.

2. International Liaison Committee on Resuscitation. 2005 International consensus on cardiopulmonary resuscitation and emergency cardio-vascular care science with treatment recommendations. Circulation 2005;112:III-1–136.

3. ECC Committee, Subcommittees and Task Forces of the American Heart Associ- ation. 2005 American Heart Association guidelines for cardiopulmonary resus- citation and emergency cardiovascular care. Circulation 2005;112:IV1–203.

4. Guyette FX, Rittenberger JC, Platt T, Suffoletto B, Hostler D, Wang HE. Feasibility of basic emergency medical technicians to perform selected advanced life support interventions. Prehosp Emerg Care 2006;10(4):518-21.

5. Voscopoulos C, Barker T, Listwa T, Nelson S, Pozner C, Liu X, et al. A Comparison of the Speed, Success Rate, and Retention of Rescue Airway Devices Placed by First-responder EMERGENCY MEDICAL TECHNICIANS: A High-fidelity Human Patient Simulation Study. J Emerg Med 2012 pii:S0736-4679(12)00867-0.

6. Deakin CD, Peters R, Tomlinson P, Cassidy M. Securing the prehospital airway: a comparison of laryngeal mask insertion and endotracheal intubation by UK paramedics. Emerg Med J 2005;22(1):64-7.

7. Barnes DR, Reed DB, Weinstein G, Brown LH. Blind tracheal intubation by paramedics through the LMA-Unique. Prehosp Emerg Care 2003;7:470–3.

8. Stone BJ, Chantler PJ, Baskett PJF. The incidence of regurgitation during cardiopulmonary resuscita- tion: a comparison between the bag valve mask and laryngeal mask airway. Resuscitation 1998;38:3e6.

9. Ocker H, Wenzel V, Schmucker P, Dörges V. Effectiveness of various airway management techniques in a bench model simulating a cardiac arrest patient. J Emerg Med 2001;20:7e12.

10. Dörges V, Ocker H, Wenzel V, Sauer C, Schmucker P. Emergency airway management by non-anaesthesia house officers e a comparison of three strategies. Emerg Med J 2001;18:90e4.

11. Dörges V, Sauer C, Ocker H, Wenzel V, Schmucker P. Airway management during cardiopulmonary resuscitationda comparative study of bagevalveemask, laryngeal mask airway and combitube in a bench model. Resuscitation 1999;41:63e9.

12. Ruetzler K, Gruber C, Nabecker S, Wohlfarth P, Priemayr A, Frass M, et al. Hands-off time during insertion of six airway devices during cardiopulmonary resuscitation: a randomised manikin trial. Resuscitation 2011;82(8):1060-3.

13. SOS-KANTO study group. Comparison of arterial blood gases of laryngeal mask airway and bag-valve-mask ventilation in out-of-hospital cardiac arrests. Circ J 2009;73(3):490-6.

14. Shin SD, Ahn KO, Song KJ, Park CB, Lee EJ. Out-of-hospital airway management and cardiac arrest outcomes: a propensity score matched analysis. Resuscitation 2012;83(3):313-9.

15. Hasegawa K, Hiraide A, Chang Y, Brown DF. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA 2013;309(3):257-66.

16. Bobrow BJ, Ewy GA, Clark L, Chikani V, Berg RA, Sanders AB, et al. Passive oxygen insufflation is superior to bag-valve-mask ventilation for witnessed ventricular fibrillation out-of-hospital cardiac arrest. Ann Emerg Med 2009;54(5):656-62.

17. Wong SC, Tariq SM. Cardiac arrest following foreign-body aspiration. Respir Care 2011;56(4):527-9.

18. Akinbami LJ, Moorman JE, Liu X. Asthma prevalence, health care use, and mortality: United States, 2005-2009. Natl Health Stat Report 2011;32:1-14.

19. Berg RA, Hilwig RW, Kern KB, Ewy GA. “Bystander” chest com- pressions and assisted ventilation independently improve outcome from piglet asphyxial pulseless “cardiac arrest.” Circulation 2000;101:1743–8.

20. Budget Accounting and Statistics Department, Taoyuan county, Population Statistics Analysis [Chinese]. Available at: tw/site/site_index.aspx?site_id=033&site_content_sn=5453.

21. Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, Inter American Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation 2004;21:233–49.

22. Becker LB, Berg RA, Pepe PE, Idris AH, Aufderheide TP, Barnes TA, et al. A reappraisal of mouth-to-mouth ventilation during bystander-initiated cardiopulmonary resuscitation. A statement for healthcare professionals from the Ventilation Working Group of the Basic Life Support and Pediatric Life Support Subcommittees, American Heart Association. Resuscitation 1997;35:189 –201.

23. Idris AH, Becker LB, Fuerst RS, Wenzel V, Rush WJ, Melker RJ, et al. Effect of ventilation on resuscitation in an animal model of cardiac arrest. Circulation 1994;90:3063–9.

24. Weaver WD, Cobb LA, Hallstrom AP, Fahrenbruch C, Copass MK, Ray R. Factors influencing survival after out-of-hospital cardiac arrest. J Am Coll Cardiol 1986;7(4):752-7.

25. Engdahl J, Bång A, Lindqvist J, Herlitz J. Can we define patients with no and those with some chance of survival when found in asystole out of hospital? Am J Cardiol 2000;86(6):610-4.

26. Gray WA, Capone RJ, Most AS. Unsuccessful emergency medical resuscitation--are continued efforts in the emergency department justified? N Engl J Med 1991;325(20):1393-8.

27. Wik L, Steen PA, Bircher NG. Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest. Resuscitation 1994;28(3):195-203.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time