Reuben Strayer is his video on BVM advocates the use of the LMA to ventilate immediatley post failed intubation instead of using the traditional BVM. This is a foreign concept to most intubators as they traditionally view the LMA as only a rescue device. However it has substantial merit.
Reasons in favour of this idea:
– LMA provides you a much better chance at effective ventilation compared with BVM
– a pre-prepared LMA (out of package, cuff deflated) can be applied and removed very quickly (10 seconds or less). Applying a BVM and obtaining the correct seal/mask position/patient position to obtain effective ventilation is about the same. The BVM can be removed quicker but is the difference in time clinically meaningful
– LMA ventilation has a substantially lower risk of causing aspiration compared with BVM as it provides reasonable airway protection (not complete) and probably creates less gastric insufflation.
So given you have a device that can be quickly applied, provide better ventilation and reduce your risk of causing aspiration perhaps this should be the first line option post failed intubation rather than BVM. Instead of thinking about the LMA as a rescue device perhaps we should be thinking of it as a standard part of our process that with proper use will substantially reduce the risk of ever needing to be rescued.
So perhaps we’d be better off setting up the intubation with the BVM set up without the mask and instead already connected to an LMA with it’s cuff deflated. Adjacent and ready to use (perhaps beneath the pillow with your suction) would be a syringe (deflate/inflate the cuff). It would be also handy to have a mask handy if you want to revert to traditional BVM although I couldn’t envisage a reason for needing the mask except for the unlikely event of an equipment failure problem with the LMA. It would be probably be an uncommon occurrence indeed for BVM ventilation work where LMA ventilation did not.
Food for thought.