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Abstract
The risk of gastric regurgitation and subsequent pulmonary aspiration is a recognised
complication of cardiac arrest--a risk which may be further increased by the resuscitative
procedure itself. The purpose of this study was to compare the incidence of gastric
regurgitation between the bag valve mask (BVM) and laryngeal mask airway (LMA). The
resuscitation data collection forms of 996 patients who underwent in-hospital cardiopulmonary
resuscitation over a 3.5 year period were reviewed. Of these, 199 patients were excluded
from the study because there was no airway management involving a BVM or LMA. The
incidence and timing of regurgitation was studied in the remaining 797 patients. Regurgitation
was recorded to have occurred at some stage in 180 of these patients (22.6%). However,
84 regurgitated prior to CPR (46.7% of those patients who regurgitated). These patients
were excluded from further analysis as regurgitation could not have been affected
by any form of ventilation. Of the remaining 713 patients, BVM ventilation was used
in 636 cases. In 170 of these the LMA was also used following the BVM. Where the patient
was ventilated with the BVM alone or BVM followed by ETT the incidence of regurgitation
during CPR was 12.4%. The LMA was used during resuscitation in 256 cases of which
170 had BVM ventilation prior to the LMA. Where the patient was ventilated with the
LMA alone or LMA followed by ETT the incidence of regurgitation during CPR was 3.5%.
The study confirms experience reported in earlier studies that when an LMA is used
as a first line airway device, regurgitation is relatively uncommon.