Airway management in athletes wearing lacrosse equipment

Context: Patient ventilation volume and rate have been found to be compromised due to the inability to seal a pocket mask over the chinstrap of football helmets. The effects of supraglottic airway devices such as the King LT and of lacrosse helmets on these measures have not been studied. Objective: To assess the effects of different airway management devices and helmet conditions on producing quality ventilations while performing cardiopulmonary resuscitation on simulation manikins. Design: Crossover study. Setting: Simulation laboratory. Patients or Other Participants: Thirty-six athletic trainers (12 men, 24 women) completed this study. Intervention(s): Airway-management device (pocket mask, oral pharyngeal airway, King LT airway [KA]) and helmet condition (no helmet, Cascade helmet, Schutt helmet, Warrior helmet) served as the independent variables. Participant pairs performed 2 minutes of 2-rescuer cardiopulmonary resuscitation under 12 trial conditions. Main Outcome Measure(s): Ventilation volume (mL), ventilation rate (ventilations/min), rating of perceived difficulty (RPD), and percentage of quality ventilations were the dependent variables. Results: A significant interaction was found between type of airway-management device and helmet condition on ventilation volume and rate (F_12,408 ¼ 2.902, P, .0001). In addition, a significant interaction was noted between airway-management device and helmet condition on RPD scores (F_6,204 ¼ 3.366, P ¼ .003). The no-helmet condition produced a higher percentage of quality ventilations compared with the helmet conditions (P .003). Also, the percentage of quality ventilations differed, and the KA outperformed each of the other devices (P .029). Conclusions: The helmet chinstrap inhibited quality ventilation (rate and volume) in airway procedures that required the mask to be sealed on the face. However, the KA allowed quality ventilation in patients wearing a helmet with the chinstrap fastened. If a KA is not available, the helmet may need to be removed to provide quality ventilations.