LMA v's Combitubes

[craig]

just asking for some information

i have been asked to write a report about the advantages of the combitube over a LMA in the BLS prehospital situation.

if anyone has any sites that have the percentages and comparisons of these could you please let me know. or you could email it to me at

parsons@hwy.com.au

the more information i have the more thorough the report

thanks

stay safe

[THE_DITCH_DOCTOR]

The major advantage that I've seen (having used both in the out of hospital setting) is that a Combitube is more stable when inserted (i.e. less likely to become dislodged) than an LMA is.

[battlemedic345]

I am told that LMA stands for Let Me Aspirate. Either is better than no airway at all, but I'll stick with the combitube for now....

[jonaeromed]

In my experience the LMA is not a good pre-hospital airway adjunct. It is very prone to being dislodged, even the AMBU one, which I prefer.

As already stated by USAFMEDIC 45 the combitube is much more stable.

I have a survey form about the LMA that was very kindly sent to me. I will send it to you and you can use it if it fits your needs.

[smle]

Where I work, LMAs are Paramedic only according to protocol, even though in NM Basics and Intermediates are trained in their use. I started my own poll about who can use LMAs here: http://www.emtcity.com/phpBB2/viewtopic.ph...&highlight=

The big issue seems to be the security of the airway. My Intermediate instructor is a Medic and RN and works on the local Life Guard chopper. He told us in class that Monday(6/6/05) that he dropped an LMA for the first time in his medical career on a Pt. who coded in the chopper. He said it worked very well and was very easy to put in.

[THE_DITCH_DOCTOR]

Where I work, LMAs are Paramedic only according to protocol, even though in NM Basics and Intermediates are trained in their use. I started my own poll about who can use LMAs here: http://www.emtcity.com/phpBB2/viewtopic.ph...&highlight=

The big issue seems to be the security of the airway. My Intermediate instructor is a Medic and RN and works on the local Life Guard chopper. He told us in class that Monday(6/6/05) that he dropped an LMA for the first time in his medical career on a Pt. who coded in the chopper. He said it worked very well and was very easy to put in.

I agree LMA's are very easy to insert, but only slightly more so than a Combitube. I just don't see any tangible benefit over a Combitube.

[craig]

thanks guys

our service is going to LMA's for LBS use the AL'S still have the option of ETT

I was on the working party that researched the combitube and the lardeal tracklight and we suggested the combitube.

but i think due to doctors feeling that medics are 'encroaching' on their skills, vetoed the combitube at the medical director level.

(our medical director sits on the state advisory panel for ALL medical applications....doctors nurses,medics etc)

thanks all

stay safe

[buddha]

Sorry to hear that the Combitube lost out to LMA in your area, Craig. After the rollout of Guidelines 2000, much discussion ensued over alternative airways. The main points that I deciphered were as follows. 1) The US is a litigious society, and the malpractice claims for bruised lips, broken teeth, vocal trauma, and etc. have hit anesthesiologists very hard. The LMA is replacing ETT in many OR procedures because of the reduced rate of complication. During my OR rotations when I was in Paramedic school (2000), this was the biggest fear/complaint among the anesthesiologists I studied under. 2) Research indicated at the time that the success rate for prehospital ET in the US was somewhere around 60-70%. Apparently we are not as good at airway management as we should be, and the AHA guidelines suggested that the LMA was easier to place and reduced traumatic complications when used by people who did not intubate on a regular basis. 3) The downside of the LMA is that, despite its ease of use, it doesn't provide a positive airway seal. The seal is marginal at best, and is very touchy to achieve. This is not a significant problem in the OR setting where patients have been NPO for hours prior to the procedure, but how many of our patients who need emergency airway management are NPO? I cannot remember one who hasn't puked. Someone above posted it correctly - LMA= Let Me Aspirate. 4) Enter the Combitube, which is another alternative airway recommended by Guidelines 2000. We carry this device, and it is intended to be strictly a "rescue airway" for use when ET is unsuccessful. The Combitube is a blind insertion device, making it simple for everyone down to EMTB level to use (depending on each state's scope of practice). Whether placed in the esophagus or the trachea, it provides a positive airway seal. It is possible to place an NG tube through the Combitube if it is in the esophagus. If you remember the EOA/EGTA that we used to use, the Combitube has the same contraindications for use (but because it doesn't rely on a mask to seal, it ventilates much better). In our area, AEMTI and above are allowed to use the Combitube if ET is unsuccessful - but no one that I know of uses the LMA prehospital. 5) Neither of these alternative airways are meant to be used long term - they are "rescue airways", and an ET can be placed around the Combitube or through the LMA (if you have the right style).