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Comparison of Different Intubation Methods in Difficult Airways during Simulated Cardiopulmonary Resuscitation with Continuous Chest Compression: A Randomized Cross-Over Manikin Trial. Emerg Med Int 2019; 2019:7306204. [PMID: 31531242 PMCID: PMC6719269 DOI: 10.1155/2019/7306204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Airway management is one of key elements of resuscitation. Endotracheal intubation is still considered the gold standard for airway management during resuscitation. Aim The aim of the study was to compare success rates and intubation time of different endotracheal intubation methods during emergency intubation with difficult airways in the conditions of cardiopulmonary resuscitation in a standardized manikin model. Methods The study was designed as a prospective, randomized, cross-over simulation study. It involved 46 paramedics with at least 5 years of experience in Emergency Medical Service. The participants performed endotracheal intubation under difficult airway conditions during continuous chest compression, implemented with the LUCAS3 chest compression system. Three methods of tracheal intubation were applied: (1) standard Macintosh laryngoscope without a bougie stylet; (2) standard laryngoscope and a standard bougie stylet; (3) standard laryngoscope and a new bougie stylet. Results The overall intubation success rate was 100% in the standard bougie and new bougie groups and lower (86.9%) when no bougie stylet was used (P=0.028). The intubation success rate with the 1st attempt equalled 91.3% for the new bougie group, 73.9% for standard bougie, and only 23.9% in the no-bougie group. The median intubation time was shortest in the new bougie group, where it amounted to 29 s (interquartile range [IQR]: 25-38); the time equalled 38s (IQR:31-44.5) in the standard bougie group and 47.5s (IQR:36-58) in the no-bougie group. The ease of use was lowest in the no-bougie group (85, IQR:63-88), average in the standard bougie group (44, IQR:30-51), and highest in the new bougie stylet group (32, IQR:19-41). Conclusion In this manikin-based study, paramedics were able to perform endotracheal intubation with higher efficacy and in a shorter time using the new bougie stylet as compared with the standard bougie stylet.
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Ruetzler K, Madziala A, Madziala M, Pruc M, Dunder D. Attitudes of firefighters towards the use of supraglottic airways devices. Am J Emerg Med 2019; 37:1392-1393. [PMID: 30674429 DOI: 10.1016/j.ajem.2019.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Kurt Ruetzler
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Outcome Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
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Ruetzler K, Gorczyca D, Plusa T, Dunder D, Kranc K. What pediatric intubation technique is most optimal for direct laryngoscopy? Pilot data. Am J Emerg Med 2019; 37:1389-1390. [PMID: 30660340 DOI: 10.1016/j.ajem.2019.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 01/12/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Kurt Ruetzler
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
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Comparison of Miller laryngoscope and UEScope videolaryngoscope for endotracheal intubation in four pediatric airway scenarios: a randomized, crossover simulation trial. Eur J Pediatr 2019; 178:937-945. [PMID: 30976922 PMCID: PMC6511341 DOI: 10.1007/s00431-019-03375-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 12/19/2022]
Abstract
With different videolaryngoscopes for pediatric patients available, UEScope can be used in all age groups. The aim of this study was to compare the Miller laryngoscope and UEScope in pediatric intubation by paramedics in different scenarios. Overall, 93 paramedics with no experience in pediatric intubation or videolaryngoscopy performed endotracheal intubation in scenarios: (A) normal airway without chest compressions, (B) difficult airway without chest compressions, (C) normal airway with uninterrupted chest compressions, (D) difficult airway with uninterrupted chest compressions. Scenario A. Total intubation success with both laryngoscopes: 100%. First-attempt success: 100% for UEScope, 96.8% for Miller. Median intubation time for UEScope: 13 s [IQR, 12.5-17], statistically significantly lower than for Miller: 14 s [IQR, 12-19.5] (p = 0.044). Scenario B. Total efficacy: 81.7% for Miller, 100% for UEScope (p = 0.012). First-attempt success: 48.4% for Miller, 87.1% for UEScope (p = 0.001). Median intubation time: 27 s [IQR, 21-33] with Miller, 15 s [IQR, 14-21] with UEScope (p = 0.001). Scenario C. Total efficiency: 91.4% with Miller, 100% with UEScope (p = 0.018); first-attempt success: 67.7 vs. 90.3% (p = 0.003), respectively. Intubation time: 21 s [IQR, 18-28] for Miller, 15 s [IQR, 12-19.5] for UEScope. Scenario D. Total efficiency: 65.6% with Miller, 98.9% with UEScope (p < 0.001); first-attempt success: 29.1 vs. 72% (p = 0.001), respectively. Intubation time: 38 s [IQR, 23-46] for Miller, 21 s [IQR, 17-25.5] for UEScope.Conclusion: In pediatric normal airway without chest compressions, UEScope is comparable with Miller. In difficult pediatric airways without chest compressions, UEScope offers better first-attempt success, shorted median intubation time, and improved glottic visualization. With uninterrupted chest compressions in normal or difficult airway, UEScope provides a higher first-attempt success, a shorter median intubation time, and a better glottic visualization than Miller laryngoscope. What is Known: • Endotracheal intubation is the gold standard for adult and children airway management. • More than two direct laryngoscopy attempts in children with difficult airways are associated with a high failure rate and increased incidence of severe complications. What is New: • In difficult pediatric airways with or without chest compressions, UEScope in inexperienced providers in simulated settings provides better first-attempt efficiency, median intubation time, and glottic visualization.
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Czekajlo M, Makomaska-Szaroszyk E, Paprocki M, Ruetzler K, Smereka J. The end of the era of endotracheal intubation as the golden standard of airway management. Am J Emerg Med 2018; 37:1194-1195. [PMID: 30342895 DOI: 10.1016/j.ajem.2018.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Michael Czekajlo
- Hounter Holmes McGuire Center for Simulation and Healthcare, Virginia Commonwealth University, Richmond, VA, USA.
| | | | | | - Kurt Ruetzler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
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Gawel WB, Kaminska H, Wieczorek W. The efficacy of endotracheal intubation utilizing INTUBRITE laryngoscope during cardiopulmonary resuscitation. Am J Emerg Med 2018; 36:1895-1896. [DOI: 10.1016/j.ajem.2018.01.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 11/29/2022] Open
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Nadolny K, Szarpak L, Gotlib J, Panczyk M, Sterlinski M, Ladny JR, Smereka J, Galazkowski R. An analysis of the relationship between the applied medical rescue actions and the return of spontaneous circulation in adults with out-of-hospital sudden cardiac arrest. Medicine (Baltimore) 2018; 97:e11607. [PMID: 30045296 PMCID: PMC6078650 DOI: 10.1097/md.0000000000011607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/28/2018] [Indexed: 12/11/2022] Open
Abstract
Sudden cardiac arrest (SCA) is a significant medical and social issue, the main cause of death in Europe and the United States.The aim of the research was to evaluate the effectiveness of emergency medical procedures applied by emergency medical teams in prehospital care in the context of return of spontaneous circulation (ROSC).The case-control study was based on the medical documentation of the Rescue Service in Katowice (responsible for monitoring 2.7 million inhabitants of the region) referring to 2016. The research involved exclusively adults (ie, individuals older than 18 years) with out-of-hospital cardiac arrest (OHCA). After considering the above inclusion criteria, there were 1603 dispatch order forms (0.64% of all dispatch orders) involved in further research.On the basis of the emergency medical procedure forms, the actions of emergency medical teams were verified as medical procedures (endotracheal intubation, the use of suction pumps, defibrillation, the use of alternatives providing airway patency and ROSC was determined.The analysis covered 1603 cases of OHCA. SCA turned out more frequent in men than in women (P = .000). Most often, SCA occurred in domestic conditions during the day and was witnessed by a third person. In 59.9% of the cases, actions were taken by witnesses, which increased the probability of ROSC. Patients were usually intubated (51.4%). Respirators were used less frequently (20.2%). Ventricular fibrillation (VF) was reported only in 22.0% of the cases. The ROSC rate was higher in the group of patients with diagnosed VF than in those with nonshockable rhythms (VF, 55.43% vs asystole, 24.05%; P = .000).Successful resuscitation depends on the quality of emergency medical procedures performed at the place of incident. The highest probability of ROSC is related with defibrillation (in the cases of VF or ventricular tachycardia with no pulse), intubation, the application of a respirator, and performing mechanical ventilation, as well as with a shorter time from dispatch to arrival.
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Affiliation(s)
- Klaudiusz Nadolny
- Department of Emergency Medicine and Disasters, Medical University of Bialystok, Bialystok
| | - Lukasz Szarpak
- Department of Emergency Medicine, Lazarski University, Warsaw
| | - Joanna Gotlib
- Division of Teaching and Outcomes of Education, Faculty of Health Sciences, Medical University of Warsaw
| | - Mariusz Panczyk
- Division of Teaching and Outcomes of Education, Faculty of Health Sciences, Medical University of Warsaw
| | - Maciej Sterlinski
- Department of Arrhythmia, The Cardinal Stefan Wyszynski Institute of Cardiology
| | - Jerzy Robert Ladny
- Department of Emergency Medicine and Disasters, Medical University of Bialystok, Bialystok
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University
| | - Robert Galazkowski
- Department of Emergency Medical Service, Medical University of Warsaw, Warsaw, Poland
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Kaminska H, Wieczorek W, Dabrowski M, Nadolny K, Smereka J. Knowledge and attitudes of paramedics toward the usage of capnography as a ventilation monitoring tool during resuscitation. Am J Emerg Med 2018; 36:1116-1117. [DOI: 10.1016/j.ajem.2017.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022] Open
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Brodecki M, Sosnowski A, Madziala M. Comparison of Macintosh and Miller laryngoscopes during pediatric resuscitation. Am J Emerg Med 2018; 36:1098-1099. [PMID: 29496366 DOI: 10.1016/j.ajem.2018.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Andrzej Sosnowski
- Norber Barlicki Memorial University Clinical Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Marcin Madziala
- International Institute of Rescue Research and Education, Warsaw, Poland; Department of Emergency Medicine, Medical University of Warsaw, Poland
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Szarpak L. The authors responds on comparing Macintosh and Miller Laryngoscopes during Pediatric Resuscitation". Am J Emerg Med 2018; 36:1099. [PMID: 29486989 DOI: 10.1016/j.ajem.2018.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, 4 Lindleya str., 02-005 Warsaw, Poland.
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Kaminska H, Wieczorek W. Comparison of two types of laryngoscopy for face-to-face intubation of a patient entrapped in a vehicle. Am J Emerg Med 2018; 36:1898-1899. [PMID: 29429795 DOI: 10.1016/j.ajem.2018.01.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Halla Kaminska
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wieczorek
- Department of Anaesthesiology, Intensive Care and Emergency Medicine in Zabrze, Medical University of Silesia, Katowice, Poland.
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Kaminska H, Gawel WB, Wieczorek W. Which option for ventilation is optimal for resuscitation performed by nurses? Pilot data. Am J Emerg Med 2018; 36:1710-1711. [PMID: 29395777 DOI: 10.1016/j.ajem.2018.01.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/23/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Halla Kaminska
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - Wladysław B Gawel
- Student's Scientific Association of Children's Diabetology of Medical University of Silesia, Poland
| | - Wojciech Wieczorek
- Department of Anaesthesiology, Intensive Care and Emergency Medicine in Zabrze, Medical University of Silesia, Katowice, Poland.
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Madziala A, Cieciel M, Konski R, Madziala M. An endotracheal tube mounted camera for intubation during cardiopulmonary resuscitation. Preliminary data. Am J Emerg Med 2018; 36:1897-1898. [PMID: 29396324 DOI: 10.1016/j.ajem.2018.01.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 01/25/2018] [Accepted: 01/27/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Agnieszka Madziala
- International Institute of Rescue Research and Education, Warsaw, Poland
| | - Michal Cieciel
- Emergency Medicine Student Scientific Circle at Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Roman Konski
- Emergency Medicine Student Scientific Circle at Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Madziala
- International Institute of Rescue Research and Education, Warsaw, Poland; Department of Emergency Medicine, Medical University of Warsaw, Poland.
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