Severe ARDS following perioperative aspiration of gastric content associated with the use of a "ProSeal™" laryngeal mask airway

A ProSeal laryngeal mask airway was used for anaesthesia for laparoscopic surgery in a 26 y old male patient with acute appendicitis. Perioperative aspiration of gastric contents resulted in severe ARDS. Invasive therapeutic options including ECMO had to be used to obtain full recovery. After critical evaluation of the chain of causation it must be postulated that an improper airway was choosen for an intervention that comprises a high risk of aspiration per se. Further risk factors were a long period of fasting, untimely removal of the mask before the patient regained full consciousness, the late confirmation of the diagnosis and the hesitant initial therapy. Since PLMA provides a higher airway occlusion pressure compared to the classic laryngeal mask airway (CLMA), the use of this device may be justified for elctive laparoscopic surgery. In emergency patients with increased risk of regurgitation endotracheal intubation still remains the gold standard.