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Andresen ÅEL, Varild Lauritzen M, Kramer-Johansen J, Kristiansen T. Implementation and use of a supraglottic airway device in the management of out-of-hospital cardiac arrest by firefighter first responders - A prospective feasibility study. Resusc Plus 2023; 16:100480. [PMID: 37840909 PMCID: PMC10568293 DOI: 10.1016/j.resplu.2023.100480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Aim We wanted to assess the implementation and use of a supraglottic airway (SGA) for on-call firefighter first responders in out-of-hospital cardiac arrest. Methods We trained 502 firefighter first responders, located at 35 fire stations in the South-East of Norway, in the use of SGA during cardiopulmonary resuscitation in adult out-of-hospital cardiac arrest. Training consisted of 45 minutes of theoretical and practical training in small groups.Primary outcome was successful ventilation with SGA assessed by both firefighter first responders and first paramedic arriving on-scene. Secondary outcomes included time expenditure and complications related to the procedure, evaluation of the training, and descriptive characteristics of the out-of-hospital cardiac arrest cases. Results An SGA was used by firefighter first responders in 23 out-of-hospital cardiac arrests, and successful ventilation was achieved in 20 (87%) cases. Air-leak was described in the three unsuccessful cases. The median procedural time was 30 seconds (IQR = 15-40), with no observed procedural complications. Firefighter first responders arrived in median time 9 minutes (IQR = 6-10 min) before the ambulance. They performed chest compressions on all patients and 6 (26%) of the patients received shock with semi-automatic external defibrillator. After training, all participants were able to successfully ventilate a manikin with the SGA. The cost of the SGA equipment for all fire stations was 3955 GBP. Conclusion Implementation of an SGA for firefighter first responders in out-of-hospital cardiac arrest management seems feasible, safe and can be introduced with limited amount of training and limited use of resources.
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Affiliation(s)
- Åke Erling L. Andresen
- Department of Research, The Norwegian Air Ambulance Foundation, P.O. Box 414 Sentrum, 0103 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
- Department of Anaesthesiology and Intensive Care, Drammen Hospital, Vestre Viken Hospital Trust, P.O. Box 800, 3004 Drammen, Norway
- Department of Prehospital Services, Vestre Viken Hospital Trust, P.O. Box 800, 3004 Drammen, Norway
| | - Magnus Varild Lauritzen
- Department of Prehospital Services, Vestre Viken Hospital Trust, P.O. Box 800, 3004 Drammen, Norway
- Department of Anaesthesiology, Ringerike Hospital, Vestre Viken Hospital Trust, P.O. Box 800, 3004 Drammen, Norway
| | - Jo Kramer-Johansen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Division of Prehospital Services, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway
| | - Thomas Kristiansen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, 0424 Oslo, Norway
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Holbery-Morgan L, Angel C, Murphy M, Carew J, Douglas F, Murphy R, Hood N, Rechtman A, Scarff C, Simpson N, Stewardson A, Steinfort D, Radford S, Douglas N, Johnson D. Competence in the use of supraglottic airways by Australian surf lifesavers for cardiac arrest ventilation in a manikin. Emerg Med Australas 2017; 29:63-68. [PMID: 28078762 DOI: 10.1111/1742-6723.12719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 09/09/2016] [Accepted: 10/26/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Lifesavers in Australia are taught to use pocket mask (PM) rescue breathing and bag valve mask (BVM) ventilation, despite evidence that first responders might struggle with these devices. Novices have successfully used the Laryngeal Mask Airway (LMA) Supreme and iGel devices previously, but there has been no previous comparison of the ability to train lifesavers to use the supraglottic airways compared to standard techniques for cardiac arrest ventilation. METHODS The study is a prospective educational intervention whereby 113 lifesavers were trained to use the LMA and iGel supraglottic airways. Comparisons were made to standard devices on plastic manikins. Successful ventilation was defined as achieving visible chest rise. RESULTS The median time to first effective ventilation was similar between the PM (16 s, 95% confidence interval 16-17 s), BVM (17 s, 16-17 s) and iGel devices (18 s, 16-20 s), but longer for the LMA (36 s, 33-38 s). The iGel frequently failed to achieve ventilation (10%) compared with the PM (1%, P < 0.01) and LMA (3%, P < 0.01) but was not worse than the BVM (3%, P < 0.57). Hands-off time was similar between the BVM, LMA and iGel (10 s for each device), but worse for the PM (13 s, P = 0.001). CONCLUSION Lifesavers using the PM and BVM perform ventilation for cardiopulmonary resuscitation well. There appears to be a limited role for supraglottic airway devices because of limitations in terms of time to first effective ventilation and reliability. Clinical validation of manikin data with live resuscitation performance is required.
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Affiliation(s)
- Lachlan Holbery-Morgan
- Life Saving Victoria, Melbourne, Victoria, Australia.,Ambulance Victoria, Melbourne, Victoria, Australia
| | - Cara Angel
- Ambulance Victoria, Melbourne, Victoria, Australia.,School of Medicine, Deakin University, Melbourne, Victoria, Australia
| | - Michelle Murphy
- Life Saving Victoria, Melbourne, Victoria, Australia.,Ambulance Victoria, Melbourne, Victoria, Australia
| | - James Carew
- Life Saving Victoria, Melbourne, Victoria, Australia
| | - Finn Douglas
- Life Saving Victoria, Melbourne, Victoria, Australia
| | - Robert Murphy
- Life Saving Victoria, Melbourne, Victoria, Australia.,Ambulance Victoria, Melbourne, Victoria, Australia
| | - Natalie Hood
- Surf Life Saving Australia, Sydney, New South Wales, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Andrew Rechtman
- Life Saving Victoria, Melbourne, Victoria, Australia.,Department of Paediatrics, Albury Base Hospital, Albury, New South Wales, Australia
| | - Christopher Scarff
- Life Saving Victoria, Melbourne, Victoria, Australia.,Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Nicholas Simpson
- Life Saving Victoria, Melbourne, Victoria, Australia.,Intensive Care Unit, University Hospital Geelong, Geelong, Victoria, Australia
| | - Andrew Stewardson
- Life Saving Victoria, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Austin Hospital, Melbourne, Victoria, Australia
| | - Daniel Steinfort
- Life Saving Victoria, Melbourne, Victoria, Australia.,Department of Respiratory Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sam Radford
- Life Saving Victoria, Melbourne, Victoria, Australia.,Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Ned Douglas
- Life Saving Victoria, Melbourne, Victoria, Australia.,Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Douglas Johnson
- Life Saving Victoria, Melbourne, Victoria, Australia.,Department of General Medicine, Austin Hospital, Melbourne, Victoria, Australia
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Adelborg K, Al-Mashhadi RH, Nielsen LH, Dalgas C, Mortensen MB, Løfgren B. A randomised crossover comparison of manikin ventilation through Soft Seal®, i-gel™ and AuraOnce™ supraglottic airway devices by surf lifeguards. Anaesthesia 2014; 69:343-7. [PMID: 24506226 DOI: 10.1111/anae.12545] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2013] [Indexed: 11/29/2022]
Abstract
Forty surf lifeguards attempted to ventilate a manikin through one out of three supraglottic airways inserted in random order: the Portex® Soft Seal®; the Intersurgical® i-gel™; and the Ambu® AuraOnce™. We recorded the time to ventilate and the proportion of inflations that were successful, without and then with concurrent chest compressions. The mean (SD) time to ventilate with the Soft Seal, i-gel and AuraOnce was 35.2 (7.2)s, 15.6 (3.3)s and 35.1 (8.5) s, respectively, p < 0.0001. Concurrent chest compression prolonged the time to ventilate by 5.0 (1.3-8.1)%, p = 0.0072. The rate of successful ventilations through the Soft Seal (100%) was more than through the AuraOnce (92%), p < 0.0001, neither of which was different from the i-gel (97%). The mean (SD) tidal volumes through the Soft Seal, i-gel and AuraOnce were 0.65 (0.14) l, 0.50 (0.16) l and 0.39 (0.19) l, respectively. Most lifeguards (85%) preferred the i-gel. Ventilation through supraglottic airway devices may be considered for resuscitation by surf lifeguards.
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Affiliation(s)
- K Adelborg
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
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Schälte G, Stoppe C, Aktas M, Coburn M, Rex S, Schwarz M, Rossaint R, Zoremba N. Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin. Scand J Trauma Resusc Emerg Med 2011; 19:60. [PMID: 22024311 PMCID: PMC3213203 DOI: 10.1186/1757-7241-19-60] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 10/24/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Supraglottic airway devices have frequently been shown to facilitate airway management and are implemented in the ILCOR resuscitation algorithm. Limited data exists concerning laypersons without any medical or paramedical background. We hypothesized that even laymen would be able to operate supraglottic airway devices after a brief training session. METHODS Four different supraglottic airway devices: Laryngeal Mask Classic (LMA), Laryngeal Tube (LT), Intubating Laryngeal Mask (FT) and CobraPLA (Cobra) were tested in 141 volunteers recruited in a technical university cafeteria and in a shopping mall. All volunteers received a brief standardized training session. Primary endpoint was the time required to definitive insertion. In a short questionnaire applicants were asked to assess the devices and to answer some general questions about BLS. RESULTS The longest time to insertion was observed for Cobra (31.9 ± 27.9 s, range: 9-120, p < 0.0001; all means ± standard deviation). There was no significant difference between the insertion times of the other three devices. Fewest insertion attempts were needed for the FT (1.07 ± 0.26), followed by the LMA (1.23 ± 0.52, p > 0.05), the LT (1.36 ± 0.61, p < 0.05) and the Cobra (1.45 ± 0.7, p < 0.0001). Ventilation was achieved on the first attempt significantly more often with the FT (p < 0.001) compared to the other devices. Nearly 90% of the participants were in favor of implementing supraglottic airway devices in first aid algorithms and classes. CONCLUSION Laypersons are able to operate supraglottic airway devices in manikin with minimal instruction. Ventilation was achieved with all devices tested after a reasonable time and with a high success rate of > 95%. The use of supraglottic airway devices in first aid and BLS algorithms should be considered.
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Affiliation(s)
- Gereon Schälte
- Department of Anesthesiology, University Hospital Aachen, Aachen, Germany
| | - Christian Stoppe
- Department of Anesthesiology, University Hospital Aachen, Aachen, Germany
| | - Meral Aktas
- Department of Pediatrics and Neonatology, University Hospital Aachen, Aachen, Germany
| | - Mark Coburn
- Department of Anesthesiology, University Hospital Aachen, Aachen, Germany
| | - Steffen Rex
- Department of Anesthesiology, University Hospital Aachen, Aachen, Germany
| | - Marlon Schwarz
- Department of Anesthesiology, University Hospital Aachen, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital Aachen, Aachen, Germany
| | - Norbert Zoremba
- Department of Anesthesiology, University Hospital Aachen, Aachen, Germany
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Comparison of manually triggered ventilation and bag-valve-mask ventilation during cardiopulmonary resuscitation in a manikin model. Resuscitation 2011; 83:488-93. [PMID: 21958929 DOI: 10.1016/j.resuscitation.2011.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 09/06/2011] [Accepted: 09/08/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND To compare a novel, pressure-limited, flow adaptive ventilator that enables manual triggering of ventilations (MEDUMAT Easy CPR, Weinmann, Germany) with a bag-valve-mask (BVM) device during simulated cardiac arrest. METHODS Overall 74 third-year medical students received brief video instructions (BVM: 57s, ventilator: 126s), standardised theoretical instructions and practical training for both devices. Four days later, the students were randomised into 37 two-rescuer teams and were asked to perform 8min of cardiopulmonary resuscitation (CPR) on a manikin using either the ventilator or the BVM (randomisation list). Applied tidal volumes (V(T)), inspiratory times and hands-off times were recorded. Maximum airway pressures (P(max)) were measured with a sensor connected to the artificial lung. Questionnaires concerning levels of fatigue, stress and handling were evaluated. V(T), pressures and hands-off times were compared using t-tests, questionnaire data were analysed using the Wilcoxon test. RESULTS BVM vs. ventilator (mean±SD): the mean V(T) (408±164ml vs. 315±165ml, p=0.10) and the maximum V(T) did not differ, but the number of recorded V(T)<200ml differed (8.1±11.3 vs. 17.0±14.4 ventilations, p=0.04). P(max) did not differ, but inspiratory times (0.80±0.23s vs. 1.39±0.31s, p<0.001) and total hands-off times (133.5±17.8s vs. 162.0±11.1s, p<0.001) did. The estimated levels of fatigue and stress were comparable; however, the BVM was rated to be easier to use (p=0.03). CONCLUSION For the user group investigated here, this ventilator exhibits no advantages in the setting of simulated CPR and carries a risk of prolonged no-flow time.
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