ACLS Provider: Course

Laryngeal Mask Airway (LMA) Insertion

The laryngeal mask airway (LMA) is a supraglottic airway device used to provide effective ventilation in patients who require airway management but cannot be intubated immediately. It is faster and easier to insert than an endotracheal tube and requires less training, making it valuable in both emergency and procedural settings. LMAs are commonly used in prehospital care, anesthesia, and as a backup airway in failed intubation scenarios.

Indications

  • Difficulty establishing an endotracheal airway.
  • Short-term airway management in surgical or emergency procedures.
  • Emergency ventilation when intubation is not immediately feasible.

Contraindications

  • High risk of aspiration (e.g., full stomach, trauma, pregnancy).
  • Severe respiratory pathology requiring high ventilatory pressures (e.g., ARDS).
  • Significant facial or upper airway trauma.

Sizing and Preparation

  • Size selection: Based on patient weight (refer to manufacturer guidelines).
  • Lubrication: Apply water-based lubricant to the back of the mask for smoother insertion.
  • Cuff inflation: Check cuff integrity prior to insertion; deflate completely before use.

Insertion Technique

  1. Position the patient in a neutral or slight sniffing position (unless cervical spine precautions are needed).
  2. Hold the LMA like a pen and insert it into the mouth, advancing along the hard palate.
  3. Continue advancing until resistance is met at the hypopharynx.
  4. Inflate the cuff with the recommended volume to seal the airway.
  5. Secure the LMA in place and connect it to a ventilation device.

Confirmation of Placement

  • Visible chest rise with ventilations.
  • Clear and equal breath sounds on auscultation.
  • Capnography (ETCO₂ waveform) confirms ventilation.
  • No air entry over the stomach (to rule out esophageal misplacement).

Potential Complications

  • Aspiration: LMAs do not fully protect the airway from gastric contents.
  • Airway obstruction: Can occur if the device folds or is malpositioned.
  • Air leak: Overinflation of the cuff or poor seal may reduce ventilation effectiveness.
  • Tissue trauma: Avoid forceful insertion to prevent injury.

Key Considerations

  • LMAs are a temporary solution; consider endotracheal intubation for long-term airway control.
  • Use caution in patients at risk for aspiration or needing high-pressure ventilation.
  • Continuously reassess airway patency and ventilation effectiveness during use.