LMA Supreme™ Training

1. LMA Supreme™ Training LMA North America Inc.

2. 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

3. 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

4. What is an LMA™? • 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

5. 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

6. 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

7. 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

8. 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

9. LMA Supreme™ – the Right Device!

11. 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. • Simple The 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. • Dependable You 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.

12. 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.

13. 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.

14. 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

15. 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!

17. 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.

18. Questions?