LMA Supreme™ Training

LMA North America Inc.

The LMA™ in EMS

• Rescue Airway use in EMS Market has been predominantly Combitube

• Studies show that Combitubes aren’t as efficacious as once thought

• Endotracheal intubation in the field is controversial as well

• A better backup/rescue airway is desperately needed

LMA™ History• The Laryngeal Mask Airway (LMA™) was invented and designed by

Dr. A.I.J. Brain in London in 1981. He identified the need for better safety, reliability and the ease of insertion of airway management devices.

• Introduced to the U.S. anesthesia market in 1992 and to the emergency market in 1996

• Included in and supported by the American Heart Association Resuscitation Guidelines

• More than 300 million uses worldwide

• Currently used in ~ 40% of all surgeries

• Supported by over 3,000 published references and growing

• Supraglottic, non-invasive airway management device• Comprised of three main components

– Airway Tube– Mask– Inflation line

• Mask designed to conform to the contours of the hypopharynx with its lumen facing the laryngeal opening

• Designed to maintain/temporize an airway in – Patients with immediate need of an airway– Patients with failed tracheal intubation or in whom

tracheal intubation is not an option– Patients in whom the benefit of establishing an airway

outweighs the risk of regurgitation and/or aspiration

What is an LMA™?

LMA™ Placement

• When fully inserted using the recommended insertion technique, the distal tip of the LMA™ cuff presses against the upper esophageal sphincter

• Its sides face into the pyriform fossae and the upper border rests against the base of the tongue

The LMA™ in EMS

• Cardiac arrest• Near drowning• Drug overdose • Trauma – including patients with serious facial or

head trauma• For rescue ventilation after failed intubation• Inability to maintain an airway or oxygenation

especially where rapid control is essential

2005 AHA Guidelines on Ventilation

• BLS - The LMA™ is an alternate airway for providers not trained in intubation

• ACLS - Studies suggest that the LMA™ can be inserted safely and can provide ventilation that is as effective as bag-mask ventilation (Class IIa).

• PALS -When endotracheal intubation is not possible, the LMA™ is an acceptable adjunct for experienced providers (Class IIb)

• Neonatal – The LMA™ is an alternative in “cannot intubate, cannot ventilate” situation

LMA™ Advantages

• Advantages over other Rescue Airways

– Fast, easy insertion– Less invasive and less traumatic for

patient– Higher first time placement rates– Shorter time to achieve an adequate

airway– Less invasive of and less traumatic to

respiratory tract– More reliable seal for successful

ventilation

LMA Supreme™ – the Right Device!

LMA Supreme™

Benefits of LMA Supreme in EMS • Fast

The LMA Supreme™ is fast and easy to insert. Successful insertion can be attained in seconds even with novice users.

• SimpleThe LMA Supreme™ is simple to use and requires minimal training to achieve success. Every LMA Supreme comes packaged sterile, new, and ready for one-time use when you need it.

• DependableYou can depend on the LMA Supreme™ to fit properly and ventilate sufficiently due to its superior design and proven track record. Stays in place during transport.

LMA Supreme™

• Indications The LMA Supreme™ is indicated for use during in emergency procedures in which tracheal intubation has failed.

The LMA Supreme™ is also indicated as a ‘rescue airway device’ in known or unexpected difficult airway situations.

The LMA Supreme™ may be used to establish an immediate clear airway during resuscitation in the profoundly unconscious patient with absent glossopharyngeal and laryngeal reflexes who may need artificial ventilation.

LMA Supreme™• Contraindications and Warnings

The risk of regurgitation and aspiration is minimized as the LMA Supreme™ offers easy access to liquid gastric content.

The LMA Supreme™ should not be used in the resuscitation or emergency situation in patients who are not profoundly unconscious and who may resist LMA Supreme™ insertion.

Instructions for Use

• Remove LMA Supreme™ from packaging• Remove plastic shell around mask and red tab on inflation line• Deflate mask• Lubricate posterior side of mask• Patient in neutral position• Hold mask by fixation tab• Press tip of cuff against hard palate• Rotate device inward with a circular motion• Advance airway into hypopharynx until resistance is felt

Instructions for Use

Inflate mask • It is recommended to start with half of the Maximum inflation volume and

continue to increase until a seal is achieved.

Connect to bag and Ventilate Use Lubrication to insert gastric tube

*Size 14 french gastric tube for Size 3, Size 16 french gastric tube for Size 4 and 5

Attach suction to end of tube to decompress and/or suction stomach

Secure with commercial grade tube holder, i.e. Thomas Tube Holder™ (Laerdal)

Available in sizes 3,4,5, pediatric sizes coming soon!

Troubleshooting Tips

• Determine proper size and insertion…teeth should be at 50% of bite block for males, and 75% of bite block for females

• Inflate with half inflation volumes. If there is leak, inflate to maximum inflation volumes marked on airway tube

• If leak persists, remove mask and go up a size and reinsert new mask. • Do Not overinflate mask. This will NOT fix the leak.

Questions?