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FREQUENTLY ASKED QUESTIONS |
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Pre-Use
Usage
LMA ™ ProSeal
LMA-Unique™
LMA-Fastrach™
LMA-Fastrach™ Endotracheal Tube
Emergency Use
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Pre-use |
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Do any LMA™ devices contain latex?
All LMA™ devices are latex-free. The LMA-Classic™, LMA-Flexible™,LMA-Fastrach™, and the LMA-ProSeal™ are made primarily of medical-grade silicone. The LMA-Unique™ is made primarily of medical-grade PVC. Click here to view the latex content statement. The statement can also be obtained from Professional Services.
Can the reusable LMA™ airways be cleaned and sterilized with alternate methods such as Steris®, Sterrad®, or pasteurization?
The Laryngeal Mask Company Limited (LMC), manufacturer of the LMA™ airways, only recommends steam sterilization for their reusable products. The other methods listed above have not been validated by the LMC or by LMA North America, Inc. Cleaning and sterilization information, including a video entitled "Taking Care of Reusable LMA™ Airways" can be obtained by contacting Professional Services.
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Usage |
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How do I select the correct size of LMA™ airway?
Optimal use of the LMA™ airway depends, in part, on appropriate size selection. The patient selection information in the table below should be used only as an approximate guide. Clinical judgment based on many patient factors, including patient anatomy and physiology as well as weight, should be used in selecting an LMA™ airway size.
| LMA™ Size* |
Patient Selection Guidelines |
Maximum Cuff Inflation Volume(ml) |
| 1 |
Neonates/infants up to 5 kg |
4 |
| 1½ |
Infants 5-10 kg |
7 |
| 2 |
Infants/children 10-20 kg |
10 |
| 2½ |
Children 20-30 kg |
14 |
| 3 |
Children 30-50 kg |
20 |
| 4 |
Adults 50-70 kg |
30 |
| 5 |
Adults 70-100 kg |
40 |
| 6 |
Adults over 100 kg |
50 |
*Full size range not available for all LMA™ airways
In general, the size 4 LMA™ airway will be suitable for most adult female patients, and the size 5 LMA™ airway for adult males up to 100 kg. The new size 6 is intended for adult patients over 100 kg. The size 3 LMA™ airway should be considered as a pediatric size.
It is very important not to exceed the maximum cuff inflation amounts. If the maximum inflation volume of air is necessary to maintain a seal, the use of a larger size mask should be considered. Clinical studies have shown that a better seal is obtained using a larger size with less air. Using too small a mask and over-inflating the cuff will decrease cuff compliance, and may result in a poor fit within the pharyngeal space. Increased leak, gastric insufflation, and malpositioning are more likely when the maximum cuff volume is exceeded, and may be associated with adverse events.
Therefore, start by choosing the largest size you think will fit and inflate with the smallest volume required to obtain an adequate seal. You will find that the larger the size used, the lower the intracuff pressure needed to obtain an adequate seal.
Consider changing to a larger size mask if leaks occur when the lungs are inflated to peak airway pressure < 20 cm H2O, but check first that this is not due to inadequate anesthesia.
It is better to use a large size with small inflation volumes than a small size excessively inflated.
Always have a larger and smaller size LMA™ airway immediately available.
Brimacombe JR, Brain AIJ. The laryngeal mask airway: A review and practical guide. WB Saunders, 1997.
Ferson D, Brimacombe JR, Brain AIJ. International Anesthesiology Clinics: The Laryngeal Mask Airway. Lippincott-Raven, Volume 36, Number 2, 1998.
Why should I try to achieve an intracuff pressure of 60 cm H2O, and how do I measure this?
There is evidence that low intracuff pressures/volumes are beneficial to patients. Low intracuff pressures (less than 60 cm H2O) have been reported to reduce the incidence of sore throat and provide better airway sealing pressures than at high cuff pressures. In addition, low cuff volumes have also been reported to provide a better seal and fiberoptic positioning than at high cuff volumes.
LMA™ intracuff pressure can be measured with any cuff measurement device used with endotracheal tubes. These devices may have different units of measurement, e.g., measure in mm Hg rather than cm H2O; 13.6 cm H2O is equivalent to 10 mm Hg, so 60 cm H2O would be equivalent to ~41 mm Hg.
Once the correct pressure is achieved, the clinician can be trained to digitally palpate the pilot balloon to correctly estimate the intracuff pressure.
Burgard G, Mollhoff T, Prien T. The effect of laryngeal mask cuff pressure on postoperative sore throat incidence. J Clin Anesth 1996;8:198-201.
Brimacombe J, Keller C, Morris R, Mecklem D. A comparison of the disposable versus the reusable laryngeal mask airway in paralyzed adult patients. Anesth Analg 1998;87:921-4.
Keller C, Puehringer F, Brimacombe J. The influence of cuff volume on oropharyngeal leak pressure and fibreoptic position with the laryngeal mask airway. Br J Anaesth 1998;81:186-7.
Keller C, Brimacombe JR. Laryngeal mask airway intracuff pressure estimation by digital palpation of the pilot balloon: a comparison of reusable and disposable masks. Anaesthesia 1999;54:183-186.
What is the risk of aspiration with the LMA™ airway
The incidence of clinically detectable regurgitation with the LMA™ airway into the pharynx has been reported in various publications at approximately 0.1%. The incidence of aspiration with the LMA™ airway is low (~2:10,000) and is comparable to the incidence of aspiration associated with outpatient general anesthesia with the face mask or endotracheal tube. The following are practical guidelines to minimize risk of aspiration:
- Carefully select the patient and surgical procedure according to approved indications and contraindications.
- Avoid inadequate anesthesia upon insertion of the LMA™ airway and during surgery.
- Avoid lubrication of anterior surface, excessive lubrication, or use of lidocaine gels containing nonaqueous solvents or silicones.
- Ensure adequate neuromuscular reversal prior to termination of general anesthesia.
- Avoid gastric distention (minimize peak airway pressures, avoid inadequate paralysis and routinely place a gastric tube when anesthetizing small infants).
Brimacombe JR, Brain AIJ. The laryngeal mask airway: A review and practical guide. WB Saunders, 1997
Brimacombe JR, Berry A. The incidence of aspiration associated with the laryngeal mask airway: A meta-analysis of published literature. J Clin Anesth 1993;7:297-305.
Why do I have trouble inserting the LMA™ device?
Some of the most common mistakes made while inserting the LMA™ airway include:
- Inadequate anesthesia may cause coughing or breathholding. Immediately deepen anesthesia and manually ventilate the patient.
- Suboptimal head/neck position. When inserting the LMA-ProSeal™, LMA-Unique™, LMA-Classic™, and LMA-Flexible™, keep the patient 's head in the sniff position. When inserting the LMA-Fastrach™, keep the patient's head in the neutral position.
- Incorrect mask deflation. Attempting to insert the LMA™ airway with the cuff partially inflated increases the chances of a downfolded epiglottis.
- Failure to press the LMA™ airway into the palatopharyngeal curve during insertion. Follow the recommended insertion techniques described in the Insertion Techniques areas of this web site.
- Lack of water-soluble lubricant on the posterior surface of the LMA™ cuff.
- Using a mask that has surpassed its useful life of 40 insertions. The cuff and airway tubes of the reusable LMA™ devices are manufactured from silicone. With each use, the silicone degrades and loses flexibility. Prior to use, be sure to perform the manufacturer recommended Pre-Use Performance Tests listed in the product instruction manuals.
Brimacombe JR, Brain AIJ. The laryngeal mask airway: A review and practical guide. WB Saunders, 1997.
How do I use the LMA™ device with positive pressure ventilation?
Positive pressure ventilation (PPV) via the LMA™ device is an established technique, effective in both children and adults. Before attempting PPV with the LMA™ airway, the clinician should be experienced using the LMA™ airway with spontaneously-breathing patients. The following are practical points to review when using the LMA™ airways with PPV:
- Use tidal volumes of approximately 8 ml/kg
- Maintain peak inspiratory pressures within the maximum airway seal pressure, on average, 30 cm H2O or less with the LMA-ProSeal™ and 20 cm H2O or less with the other LMA™ airways
- Control end-tidal CO2 by altering respiratory rate
- PPV with the LMA™ airway may be achieved with and without muscle relaxants. When a relaxant technique is chosen, the relaxant drug may be given either before or after insertion.
Leaks during PPV may be attributable to light anesthesia, inadequate muscle relaxant, use of too small an LMA™ airway, a reduction in lung compliance related to the surgical or diagnostic procedure, patient factors, or displacement of the LMA™ airway by head turning or traction.
During the recovery period, reverse the muscle relaxant or allow it to wear off before switching off the anesthetic agents at the end of the procedure. With gentle, assisted ventilation, the patient should be allowed to start breathing.
Brain AIJ, Denman W, Goudsouzian N.G., LMA-Classic and LMA-Flexible Instruction Manual, LMA North America, Inc.
Brimacombe JR, Brain AIJ. The laryngeal mask airway. A review and practical guide. WB Saunders, 1997.
How do I manage an air leak with the LMA™airway?
An air leak may have several causes.
- Prior to insertion, be sure the LMA™ device is in proper working order, doesn't have a hole in the mask or inflation line, and has passed all the recommended Pre-Use Tests.
- Inadequate anesthesia can cause an air leak around the mask of the LMA™ device. Deepen the level of anesthesia to see if the leak subsides.
- An improperly placed LMA™ airway, a mask with too little or too much air in the cuff, an LMA™ cuff that has folded back on itself, and/or too small an LMA™ device for size of the patient can cause an air leak. Check the position of the LMA™ cuff and reinsert or replace, as necessary. Do not simply add more air to the cuff, as adding air may increase tension in the cuff, pushing it away from the laryngeal opening.
- When using assisted or positive pressure ventilation with the LMA™ device, high airway pressures can cause the mask to leak. Reduce the airway pressure by lowering the tidal volume, lowering the inspiratory flow rate, increasing muscle relaxation, or treating bronchospasm if present.
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How long can I leave the LMA™ airway in place?
LMA-Classic™, LMA-Flexible™, LMA-Unique™, & LMA-ProSeal™
The maximum duration for which an LMA™airway can safely be used is not yet known; however, there is increasing evidence that the LMA™ airway may be safe for elective procedures in healthy patients lasting 4 to 8 hours in the hands of experienced users. If the LMA™ airway is used for prolonged periods, the respiratory function must be closely monitored, and a heat and moisture exchanger should be used. Also, intracuff pressures should be checked periodically and maintained at 60 cm H2O. Nitrous oxide diffusion tends to cause a rise in intracuff pressure in the LMA™ cuffs made of silicone. This may result in malposition, postoperative sore throat, or other adverse events.
Brain AIJ, Denman W, Goudsouzian N.G., LMA-Classic and LMA-Flexible Instruction Manual, LMA North America, Inc.
Ferson D, Brimacombe JR, Brain AIJ. International Anesthesiology Clinics: The Laryngeal Mask Airway. Lippincott-Raven, Volume 36, Number 2, 1998.
LMA-Fastrach™
There are reports of pharyngeal edema and increased mucosal pressure attributed to the rigidity of the airway tube. Therefore, it is recommended the LMA-Fastrach™ be removed once intubation has been accomplished. If the LMA-Fastrach™ is left in place after intubation, the cuff should be partially deflated (to a pressure of 20-30 cm H2O).
The LMA-Fastrach™ can be used as a stand-alone device for ventilation. There are no clinical data on how long the LMA-Fastrach™ may be left in place, but there are anecdotal reports of leaving the LMA-Fastrach™ in place for up to 4 hours without sequelae. If a clinical decision is made to leave the LMA-Fastrach™ in place, the tube should be stabilized in the neutral position to prevent unnecessary movement.
Brain AIJ, Verghese C., LMA-Fastrach™ Instruction Manual, LMA North America, Inc.
Keller C, Brimacombe J. Pharyngeal mucosal pressures, airway sealing pressures, and fiberoptic position with the intubating versus the standard laryngeal mask airway. Anesthesiology 1000;90:1001-6.
Nakasawa K, Tanaka N, Ishikawa S et al. Using the intubating laryngeal mask airway (LMA-Fastrach) for blind endotracheal intubation in patients undergoing cervical spine operation. Anesth Analg 1999;89:1319-21.
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Can I remove the LMA™ airway with the cuff inflated?
Provided the patient is awake and airway reflexes have returned, cuff deflation prior to removal is not essential. However, it is preferable to remove the LMA™ airway deflated to prevent damage to the cuff from sharp teeth.
In some situations, clinicians prefer to remove the LMA™ with cuff inflated, primarily to remove secretions that collect on top of the cuff. This is particularly true of patients undergoing nasal/throat surgery where bleeding from above the airway has collected on the LMA™ cuff. Rarely it may be difficult to remove the LMA™ airway inflated due to the cuff becoming caught under the base of the tongue.
It should also be noted that if intubation has been performed using the LMA-Classic™, LMA-Unique™, or LMA-Fastrach™ as a conduit, removal of the LMA™airway with the cuff inflated may inadvertently dislodge or move the endotracheal tube.
Can I use the LMA™ airways in laser surgery?
The LMA-Classic™, LMA-Flexible™, and LMA-Unique™have been studied in vitro with various types of lasers and clinical reports have appeared in the literature; however, there are no recommendations for use of the LMA™airways in laser surgery.
Brimacombe J. The incendiary characteristics of the laryngeal and reinforced laryngeal mask airway to CO2 laser strike - A comparison with two polyvinyl chloride tracheal tubes. Anaesth Intens Care 1994;22:694-697.
Divatia JV, Sareen R, Upadhye SM, Sharma KS, Shelgaonkar JR. Anaesthetic management of tracheal surgery using the laryngeal mask airway. Anaesth Intens Care 1994;22:69-73.
Epstein RH, Halmi W. Oxygen leakage around the laryngeal mask airway during laser treatment of port wine stains in children. Anesth Analg 1994;78:486-490.
Jameson JJ, Moses RD, Vellayappan U, Lathi KG. Use of the laryngeal mask airway for laser treatment of the subglottis. Otolaryngol Head Neck Surg 2000;123:101-2.
Keller C, Brimacombe J, Coorey A, Wood V, Keller K. Liability of laryngeal mask airway devices to thermal damage from KTP and Nd:YAG lasers. Br J Anaesth 1999;82:291-294.
Pandit JJ, Chamber P, O'Malley S. KTP laser-resistant properties of the reinforced laryngeal mask airway. Br J Anaesth 1997;78:594-600.
Sher M. Brimacombe J, Laing D. Anaesthesia for laser pharyngoplasty-a comparison of the tracheal tube with the reinforced laryngeal mask airway. Anaesth Intens Care 1995;23:149-153.
Slinger P, Robinson R, Shennib H, Benumof JL, Eisenkraft JB. Alternative technique for laser resection of a carinal obstruction. J Cardiothorac and Vasc Anesth 1992;6:749-755.
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Is the LMA™ device safe in the MRI environment?
The LMA-ProSeal™, LMA-Classic™, and LMA-Flexible™, and LMA-Fastrach™ endotracheal tube are MR safe when properly positioned and secured with tape under the following conditions:
- Shielded MRI system with static magnetic fields of 1.5 Tesla or less,
- Gradient magnetic fields of 20 Tesla/second or less, and
- Maximum whole body averaged specific absorption rate (SAR) of 1.4 W/kg (1.1 W/kg for LMA-Fastrach™ endotracheal tube) for 30 minutes of imaging.
If MRI is done in close proximity to the LMA-Flexible™, LMA-ProSeal™, or LMA-Fastrach™ endotracheal tube, there will be distortion of the image in the area surrounding the airway due to the wire component of the airway tube.
The LMA-Unique™ has not been tested for MRI compatibility; however, its characteristics would be most similar to the LMA-Classic™, as both of these LMA™ airways only have a small amount of metal within the valve in the pilot balloon.
The LMA-Fastrach™ is contraindicated for use with MRI.
Refer to the appropriate instruction manual for complete MRI test results.
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LMA-ProSeal™ |
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Should I insert a gastric tube every time the LMA-ProSeal™ is used? If I insert a gastric tube, can I leave it in place for the duration of the procedure?
The drain tube has been designed primarily as a passive drainage channel and as an indicator of correct mask placement. The feature of allowing the passage of a gastric tube is an additional advantage. Initially, it may be useful for clinicians to insert a gastric tube as they are learning to use the LMA-ProSeal™.
Use of a gastric tube is a clinical decision, depending on many variables, including the nature of the case and the surgeon. If used, it may be inserted, the stomach drained, and the tube removed. Alternatively, it may be left in for the duration of the case on low suction or open to the atmosphere. It should be noted that leaving a gastric tube in place decreases the lumen size of the drain tube for its primary function of facilitating drainage.
What should I do if I feel resistance when trying to pass the gastric tube?
Never use force when passing the gastric tube. If resistance is felt, check for adequate lubrication and make another gentle attempt. It resistance is encountered at 21.5 cm, check placement, as the mask tip is likely folded back on itself. It is sometimes possible to flip the mask tip into place with digital manipulation; however, usually, the mask should be removed and reinserted.
Can I intubate through the LMA-ProSeal™?
The airway tube of the LMA-ProSeal™ has a smaller diameter than that of the LMA-Classic™ and LMA-Fastrach™, but is sufficiently wide and short enough to accommodate endotracheal tubes in an emergency or difficult airway situation, if desired. The size 4 LMA-ProSeal™ will allow passage of a size 5 uncuffed endotracheal tube and the size 5 LMA-ProSeal™ will allow passage of a size 6 cuffed endotracheal tube. In general, however, when intubation is anticipated, the LMA-Fastrach™ should be used.
Why is there an Introducer tool for the LMA-ProSeal™?
The Introducer was developed to facilitate correct insertion for those persons who did not wish to place a finger into the patient's mouth. It can make insertion easier for the inexperienced LMA™ airway user. It may also be desirable to use the Introducer if the patient poses an infection risk.
Why is there a dedicated Cuff-Deflator tool for the LMA-ProSeal™
Proper deflation of any LMA™ airway is paramount to successful insertion and placement. A fully-deflated LMA™ cuff without any wrinkles and with a flat tip reduces the risk of the cuff tip entering the valleculae or the glottic opening and facilitates passage of the cuff behind the cricoid cartilage.
The cuff of the LMA-ProSeal™ differs from the other LMA™ airways in having a rear component as well as the main cuff. In addition, the main cuff is larger and longer than other LMA™ airways, with a posterior extension to increase the seal. Finally, the distal drain tube makes compression of the cuff tip more difficult. The LMA-ProSeal™ Cuff-Deflator was designed to apply the correct pressure to the cuff during deflation, especially to the cuff tip and the drain tube.
We recommend that the Cuff-Deflator be used prior to steam autoclaving to ensure removal of all the air from the cuff. Any air or moisture in the cuff will expand at the high temperatures and low pressures of the autoclave, causing irreparable damage (herniation or rupture) to the cuff and/or pilot balloon
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LMA-Unique™ |
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Why is the LMA-Unique™ packaged sterile?
The LMA-Unique™ is particularly useful for stocking crash carts and supplementing the reusable LMA™ airway supply in peak usage periods. It is also ideal for other areas where sterilization equipment may not be available or in patients where infection transmission may be a concern. By providing the LMA-Unique™ sterile, it is ready for immediate use.
What happens if I steam autoclave the LMA-Unique™?
The LMA-Unique™ will melt if placed in the autoclave.
Is there an expiration date or shelf life for the LMA-Unique™?
There is an expiration date printed on the lid. Sterility is guaranteed to this date, provided the package is not opened or damaged.
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LMA-Fastrach™ |
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Can I use a standard PVC endotracheal tube with the LMA-Fastrach™
The LMA-Fastrach™ was designed as a conduit for blind intubation. Using the specialized endotracheal tube provided with the LMA-Fastrach™ optimizes the rate of successful intubation. The straight, wire-reinforced silicone endotracheal tube points directly to the center of the glottis and vocal cords as it is advanced through the mask aperture. Additionally, the tip of the silicone endotracheal tube is much softer than a polyvinyl chloride (PVC) endotracheal tube and is specially molded to avoid trauma to the vocal cords.
In contrast, the shape of a PVC endotracheal tube is pre-curved to facilitate placement with the use of a curved laryngoscope blade. The shape of the metal tube of the LMA-Fastrach™ exaggerates the curvature of the standard PVC endotracheal tube, and as a result, the tip of the endotracheal tube may push against the anterior glottis and vocal cords, which can cause trauma. However, it has been reported that insertion of a PVC endotracheal tube into the LMA-Fastrach™ airway tube with the curvature reversed (in a cephalad direction) may increase the chance of successful intubation.
Ferson D, Brimacombe JR, Brain AIJ. International Anesthesiology Clinics: The Laryngeal Mask Airway. Lippincott-Raven, Volume 36, Number 2, 1998.
Brain AIJ, Verghese C, Addy EV, Kapila A, Brimacombe JR. The intubating laryngeal mask. II: a preliminary clinical report of a new means of intubating the trachea. Br J Anaesth 1997;79,6:704-709.
Rosenblatt WH, Murphy M. The intubating laryngeal mask: use of a new ventilating-intubating device in the emergency department. Annals Emerg Med 1999;33:234-238.
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LMA-Fastrach™ Endotracheal Tube |
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How long can an LMA-Fastrach™ endotracheal tube stay in place?
The cuff of the LMA-Fastrach™ endotracheal tube is characterized as being low volume, high pressure. However, as Dr. Brain, the inventor, points out, "this term is misleading when applied to this specialized tube." Studies have shown that the LMA-Fastrach™ endotracheal tube cuffs are lower pressure than the older red rubber endotracheal tubes that were associated with ischemic changes during long term use. In addition, part of the cuff pressure that is required to stretch the cuff wall itself is not transmitted to the tracheal walls. At "just seal" or "minimal occlusion volumes", mucosal pressures should remain within safe limits.
There are currently no clinical data on how long an LMA-Fastrach™ endotracheal tube can remain in place and clinical judgment must be used in each situation. In all situations, care should be taken to limit cuff inflation to a "just seal" pressure.
Riley E, DeGroot K, Hannallah M. The high-pressure characteristics of the cuff of the intubating laryngeal mask endotracheal tube. Anesth Analg 1999;89:1588.
Weisel S, Warm T. Fastrach uses a low-volume, high-pressure cuff for the endotracheal tube system. Anesthesiology 1999;91:592-593. Reply by Young, 593-595.
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Emergency Use |
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What is the incidence of regurgitation and aspiration with LMA™ airway use in the field?
There are relatively few studies or publications to date on use of the LMA™ airway in the pre-hospital setting. In general, the incidence of regurgitation/aspiration directly associated with LMA™ airway placement is low. It would appear that most cases of regurgitation occurred during CPR prior to airway placement. However, it is possible that more cases will be seen as the LMA™ airway is used more often in the pre-hospital setting with operators less-experienced with the device.
Grantham H, Phillips G, Gilligan JE. The laryngeal mask in pre-hospital emergency care. Emergency Medicine 1994;6:193-197.
Rumball CJ, MacDonald D. The PTL, Combitube, laryngeal mask, and oral airway: Randomized prehospital comparative study of ventilatory effectiveness and cost-effectiveness in 470 case of cardiopulmonary arrest. Prehospital Emergency Care 1997;1:1-10.
Stone BJ, Chantler PH, Baskett PJF. The incidence of regurgitation during cardiopulmonary resuscitation: a comparison between the bag valve mask and laryngeal mask airway. Resuscitation 1998;38:3-6.
Can the LMA™ airway tube be used as a conduit for emergency resuscitation medications?
There have been very few reports of administering drugs through the LMA™ airway tube, with contrasting results. In one cadaver study, epinephrine was successfully delivered to the lungs in "reasonable" amounts. However, in 100 anesthetized patients using a special cannula, drugs were found in only 27% or patients. Therefore, drug dispersal through the LMA™ airway tube is not a reliable way to administer medications, but may be worth a try in a resuscitation patient without an endotracheal tube or venous access.
Alexander R, Swales H, Pickford A, Smith GB. The laryngeal mask airway and the tracheal route for drug administration. Br J Anaesth 1997;78:220-1.
Challiner A, Rochester S, Mason C, Anderson H, Walmsley A. Spread of intrapulmonary adrenaline administered via the laryngeal mask. Resuscitation 1997;34:193.
What is the role of the LMA™ airway in the new American Heart Association (AHA) Guidelines?
In adult Basic Life Support (BLS), the LMA™ airway is recommended as an alternative airway device to the bag-mask. The LMA™ airway may be considered a first choice resuscitation airway for BLS providers who are not trained in intubation.
In adult Advanced Cardiovascular Life Support (ACLS), the LMA™ airway is recommended as a Class IIa device, defined as "Interventions are acceptable, safe, and useful. Considered within standard of care, reasonably prudent physicians can choose. Considered optional or alternative interventions by majority of experts." The LMA™ airway is an airway adjunct and can be used if tracheal intubation is not possible.
In Pediatric Advanced Life Support (PALS), the LMA™ airway is classified as a Class Indeterminate device, defined as "Interventions can still be recommended for use, but reviewers must acknowledge that research quantity/quality fall short of supporting a final class decision. Indeterminate is limited to promising interventions." Therefore, the LMA™ airway may be utilized depending on the situation at the time of the arrest.
In Neonatal Resuscitation, the LMA™ airway is an alternative in the "cannot intubate, cannot ventilate" situation.
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