The Application And Popularization Of Laryngeal Mask Airway In Community Hospital

【Background】In addition to the correct chest compressions,it should also be effective as soon as possible to open the airway means to achieve high quality cardiopulmonary resuscitation.Endotracheal intubation is a truly "measures of gold" to achieve effective ventilation,keep respiratory tract unobstructed,achieve the airway patency.However,endotracheal intubation is a traumatic operation,the technical requirements of the operator is relatively high.Once the operation is careless,it is easy to cause medical disputes.Laryngeal mask airway[1,2] is a device developed by the British Brain in 1981 according to the design of the human laryngeal anatomy.It is a new type of supraglottic airway device which is located between the mask and endotracheal intubation.At present,it is mainly used in the management of general anesthesia,the management of respiratory tract and the maintenance of artificial airway in patients with difficult intubation,but there is still no research on how to use laryngeal mask airway in community hospital.Under this background,In the "2014 Shanghai municipal hospital for joint development of technology application and promotion project",the group members set up the project of the laryngeal mask and femoral vein puncture technique in community emergency application and promotion ",focuses on the application of laryngeal mask and promotion in the community in emergency.This study used a randomized method,investigate the effect of laryngeal mask in recovery of the operating essentials and advantages,community hospital emergency ventilation efficacy and adverse reactions,and a preliminary assessment of the safety and feasibility of laryngeal mask airway in a community hospital in emergency.【Target】Based on the relevant training of medical staff in community hospital,the laryngeal mask airway ventilation technology.The LMA technology used to aid in the community to observe the LMA in the community hospital emergency resuscitation feasibility,effectiveness and safety.【Technology】1.Select 168 doctors from two community hospitals,which are without tracheal intubation and laryngeal mask using the experience,give them the use of laryngeal mask for skills training,and apply skill to the human body model,until the master skill.From September 2014 to July 2016,61 patients with sudden cardiac arrest,respiratory failure or sighing respiration were collected from 2 community hospitals.Standard of cardiac arrest diagnostic criteria: Patients with cardiac arrest sudden loss of consciousness disappeared;arterial pulse disappeared or heart sounds,and demonstrated by electrocardiogram and cardiac arrest,ventricular fibrillation,pulseless electrical activity.Exclusion criteria: serious injury to open airway manipulation;in patients with advanced malignant tumor,cachexia;cardiac respiratory arrest more than 30min;oropharyngeal pathological changes,tracheotomy and aspiration were hematemesis,history.The hospital ethics committee and informed consent of the patient’s family approved this study.2.Selected patients were randomly divided into two groups according to their date of treatment.The date is numbered divided into the mask group,the date is even divided into the mask group.Laryngeal mask group: using the ProSeal laryngeal mask and simple breathing bag ventilation emergency ventilation,a total of 31 cases,16 cases of male patients and 15 female patients,aged 53-90 years,average 71.7 11.1 years old.Mask group: the use of mask + simple breathing capsule ventilation,a total of 30 cases,14 cases of male patients,16 cases of female patients,aged 55-92 years,mean 73.5± 9.3 years old.3.Observable index: Laryngeal mask or mask to connect a simple breathing bag,oxygen flow 6-8L / min,oxygen concentration of nearly 100%,tidal volume of 8-10 ml / kg,ventilation frequency of 10 times / min.4.The method of resuscitation: Two groups of patients after diagnosis,adult cardiopulmonary resuscitation guidelines were immediately in accordance with the 2010 American Heart Association issued to give the correct and effective chest compressions,the need for defibrillation patients to be positive and timely defibrillation treatment.,norepinephrine,respiratory stimulants,dopamine,sodium bicarbonate and other cardiopulmonary resuscitation drugs,dose,usage of the two groups no difference.Given adrenaline,norepinephrine,respiratory stimulants,dopamine,sodium bicarbonate and other cardiopulmonary resuscitation drugs,dose,usage of the two groups no difference.Conduct sustained ECG,pulse and oxygen saturation monitoring.After the success of the two groups were transferred to our hospital emergency department and then tracheal intubation.5.Observed indicator(1)The success rate and frequency of laryngeal mask airway insertion.(2)The opening time of the airway: when the mask is successful,the time when patient will be able to reach the effective ventilation after the access to the self inflating bag.(3)Independent circulation recovery indicators: values Of SPO2 which 5 min(T1),10 min(T2),20 min(T3)after putted mask.(4)Cardiopulmonary resuscitation success cases: the number of success cases after 30 min cardiopulmonary resuscitation.Cardiopulmonary resuscitation success criteria: a).heartbeat recovery;b).complexion,lips from cyanosis to rosy;c).spontaneous breathing rules or irregular breathing,percutaneous blood oxygen saturation greater than 90%;d).pupil change from big to small,and have Light reaction or eye movement.(5)arterial blood gas(PH、PO2、PCO2),lactic acid,blood glucose。(6)Adverse reactions: adverse reactions including mask gastric dilatation,abdominal distension,vomiting,facial injury,pressure leakage;laryngeal mask adverse reactions include nausea and vomiting,abdominal distension,respiratory tract hemorrhage,laryngospasm,laryngeal edema,leakage etc.【Statistical analysis】All data analyzed using SPSS19.0 statistical software.The measurement data are expressed as mean and standard deviation()and are compared by t-test.The differences between groups were analyzed by two independent samples t-test.Count data using chi-square test,do not meet the chi-square test conditions using the exact probability method.The data was considered statistically significant when P<0.05.【Results】1.There was no significant difference between the two groups in sex,age and weight(P>0.05).2.The airway opening time: Rate of successful first insertion was 93.5% for laryngeal mask group.There are 2 cases of patients with 2 times laryngeal mask insertion was successful.The average time of airway opening in laryngeal mask airway group was(29.84 ±5.15s).The mask group complete airway opening time for an average of(10.20±3.22s).There was statistical significance between the two groups(P<0.01).3.Comparison of two groups of patients with cardiopulmonary resuscitation: The number of patients with laryngeal mask airway in 5min,10 min,20min three time points of SpO2 > 90% was significantly higher than that of mask group,the difference was statistically significant(P<0.05).The results showed that laryngeal mask recovery was better than that of mask group.4.The number of cases of successful cardiopulmonary resuscitation: The number of successful cardiopulmonary resuscitation(CPR)in laryngeal mask group was 14(45.2%)at 30 min time point.But the number of successful cases of cardiopulmonary resuscitation was 6 cases(20%)for mask group.So laryngeal mask group was better than mask group,the difference was statistically significant(P<0.05).5.There was no significant difference in serum 30min(PH,PCO2),lactic acid and blood glucose between the two groups before and after cardiopulmonary resuscitation.But the D-value of PO2 laryngeal mask airway group(40.7±5.6)mmHg was greater than that of the mask group(32.7±3.3)mmHg,the difference was statistically significant(P<0.05).6.Adverse reactions found in laryngeal mask group including abdominal distention(3 cases),gastroesophageal reflux(1 case),air leak(5 cases).Adverse reactions found in laryngeal mask group including gastric inflation(10 cases),aspiration of gastric contents(7 cases),air leak(10 cases).The incidence rate of gastric distention,aspiration rate of gastric contents and the rate of airway leakage were significantly higher than those of laryngeal mask group(P<0.05).【Conclusions】In patients with cardiopulmonary resuscitation,the count of patients which SpO2> 90% in the laryngeal mask group was significantly higher than that in the mask group at the time of 5min,10 min and 20 min,the same situation was found in the count of successful cardiopulmonary resuscitation at the time of 30 min.The incidence of adverse reactions(incidence of gastric swelling,gastric aspiration rate and airway leakage rate)was significantly lower than that of the mask group,but the operation time was significantly longer than that of the mask group.For the need for cardiopulmonary resuscitation in patients with first aid,laryngeal mask ventilation is better.With effectively opening the patient airway,high security,LMA was worth of promoting the use of emergency in the community hospital.