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Thomas J, Crowe R, Schulz K, Wang HE, De Oliveira Otto MC, Karfunkle B, Boerwinkle E, Huebinger R. Association Between Emergency Medical Service Agency Intubation Rate and Intubation Success. Ann Emerg Med 2024; 84:1-8. [PMID: 38180402 DOI: 10.1016/j.annemergmed.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/10/2023] [Accepted: 11/03/2023] [Indexed: 01/06/2024]
Abstract
STUDY OBJECTIVE Airway management is a crucial part of out-of-hospital care. It is not known if the rate of overall agency intubation attempts is associated with intubation success. We sought to evaluate the association between agency intubation attempt rate and intubation success using a national out-of-hospital database. METHODS We conducted a retrospective secondary analysis of the ESO Data Collaborative from 2018 to 2019, and included all adult cases with an endotracheal intubation attempt. We calculated the number of intubations attempted per 100 responses, advanced life support responses, and transports for each agency. We excluded cases originating at health care facilities and outliers. We used multivariable logistic regression to evaluate the association between agency intubation attempt rate and 1) intubation success and 2) first-pass success. We adjusted for confounders. RESULTS We included 1,005 agencies attempting 58,509 intubations. Overall, the intubation success rate was 78.8%, and the first-pass success rate was 68.5%. Per agency, the median rate of intubation attempts per 100 emergency medical service responses was 0.8 (interquartile range 0.6 to 1.1). Rates of intubation attempts per 100 responses (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI] 1.6 to 1.8), advanced life support responses (aOR 1.18; 95% CI 1.16 to 1.20), and transports (aOR 1.21; 95% CI 1.18 to 1.22) were all associated with intubation success. These relationships were similar for first-pass success but with smaller effect sizes. CONCLUSION Higher agency rates of intubation attempts were associated with increased rates of intubation success and first-pass success.
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Affiliation(s)
- Jordan Thomas
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX
| | | | - Kevin Schulz
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX; Texas Emergency Medicine Research Center, McGovern Medical School, University of Texas Health Science Center, Houston, TX; Houston Fire Department, Houston, TX
| | - Henry E Wang
- Department of Emergency Medicine, the Ohio State University, Columbus, OH
| | | | - Bejamin Karfunkle
- Texas Emergency Medicine Research Center, McGovern Medical School, University of Texas Health Science Center, Houston, TX
| | | | - Ryan Huebinger
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX; Texas Emergency Medicine Research Center, McGovern Medical School, University of Texas Health Science Center, Houston, TX; Department of Emergency Medicine (Huebinger), University of New Mexico, Albuquerque, NM.
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Carney N, Totten AM, Cheney T, Jungbauer R, Neth MR, Weeks C, Davis-O'Reilly C, Fu R, Yu Y, Chou R, Daya M. Prehospital Airway Management: A Systematic Review. PREHOSP EMERG CARE 2022; 26:716-727. [PMID: 34115570 DOI: 10.1080/10903127.2021.1940400] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Objective: To assess comparative benefits and harms across three airway management approaches (bag valve mask [BVM], supraglottic airway [SGA], and endotracheal intubation [ETI]) used by prehospital emergency medical services (EMS) to treat patients with trauma, cardiac arrest, or medical emergencies, and how they differ based on techniques and devices, EMS personnel and patient characteristics. Data sources: We searched electronic citation databases (Ovid® MEDLINE®, CINAHL®, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus®) from 1990 to September 2020. Review methods: We followed Agency for Healthcare Research and Quality Effective Health Care Program Methods guidance. Outcomes included mortality, neurological function, return of spontaneous circulation (ROSC), and successful advanced airway insertion. Meta-analyses using profile-likelihood random effects models were conducted, with analyses stratified by study design, emergency type, and age. Results: We included 99 studies involving 630,397 patients. We found few differences in primary outcomes across airway management approaches. For survival, there was no difference for BVM versus ETI or SGA in adult and pediatric patients with cardiac arrest or trauma. For neurological function, there was no difference for BVM versus ETI and SGA versus ETI in pediatric patients with cardiac arrest. There was no difference in BVM versus ETI in adults with cardiac arrest, but improved neurological function with BVM or ETI versus SGA. There was no difference in ROSC for patients with cardiac arrest for BVM versus ETI or SGA in adults and pediatrics, or SGA versus ETI in pediatrics. There was higher frequency of ROSC in adults with SGA versus ETI. For successful advanced airway insertion, there was higher first-pass success with SGA versus ETI for all patients except adult medical patients (no difference), and no difference in overall success using SGA versus ETI in adults. Conclusions: The currently available evidence does not indicate benefits of more invasive airway approaches based on survival, neurological function, ROSC, or successful airway insertion. Strength of evidence was low or moderate; most included studies were observational. This supports the need for high-quality randomized controlled trials to advance clinical practice and EMS education and policy, and improve patient-centered outcomes.
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Foorman B, Utarnachitt RB, Danielson K, Brookie T, Henry L, Latimer A. Prolonged Use of an Extraglottic Airway During Air Medical Transport From a Remote Alaskan Island. Air Med J 2022; 41:491-493. [PMID: 36153148 DOI: 10.1016/j.amj.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/10/2022] [Indexed: 06/16/2023]
Abstract
Extraglottic devices (EGDs) are important tools for airway management in the prehospital and transport medicine environment. EGDs may be used as either a primary airway or rescue device depending on the provider skill level or patient circumstances. Although EGDs do not provide a definitive airway, they can facilitate oxygenation and ventilation in select patients. This is particularly important in the remote or austere environment when difficult airways are infrequently encountered. This case report details the prolonged use of an EGD during air medical transport from a rural Alaskan medical clinic to a large academic tertiary receiving facility, with the total time until definitive airway placement of approximately 9 hours. We review the prehospital coordination and evaluation, in-flight management, and successful transfer of care of the patient to the receiving tertiary center for definitive intervention.
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Affiliation(s)
- Benjamin Foorman
- Airlift Northwest, Seattle, WA; Harborview Medical Center, Department of Emergency Medicine, University of Washington, Seattle, WA.
| | - Richard B Utarnachitt
- Airlift Northwest, Seattle, WA; Harborview Medical Center, Department of Emergency Medicine, University of Washington, Seattle, WA
| | | | | | | | - Andrew Latimer
- Airlift Northwest, Seattle, WA; Harborview Medical Center, Department of Emergency Medicine, University of Washington, Seattle, WA
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Dufour-Neyron H, Tanguay K, Nadeau A, Emond M, Harrisson J, Robert S, Capolla-Daneau N, Groulx M, Carmichael PH, Mercier E. Prehospital Use of the Esophageal Tracheal Combitube Supraglottic Airway Device: A Retrospective Cohort Study. J Emerg Med 2022; 62:324-331. [PMID: 35067394 DOI: 10.1016/j.jemermed.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/26/2021] [Accepted: 11/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the province of Quebec (Canada), paramedics use the esophageal tracheal Combitube (ETC) for prehospital airway management. OBJECTIVES Our main objective was to determine the proportion of patients with successful ventilation achieved after ETC use. Our secondary aim was to determine the number of ETC insertion attempts required to ventilate the patient. METHOD This is a retrospective cohort study. All patients who had ≥1 attempt to insert an ETC during prehospital care between January 1, 2017 and December 31, 2018 were included. Prehospital and in-hospital data were extracted. Successful ventilation was defined as thorax elevation, lung sounds on chest auscultation, or positive end-tidal capnography after ETC insertion. RESULTS A total of 580 emergency medical services interventions (99.3% cardiac arrests) were included. Most patients were men (62.5%) with a mean age 67.0 years (SD 17.6 years), and 35 (13.1%) of the 298 patients transported to emergency department survived to hospital discharge. Sufficient information to determine whether ventilation was successful or not was available for 515 interventions. Ventilation was achieved during 427 (82.7%) of these interventions. The number of ETC insertion attempts was available for 349 of the 427 successful ETC use. Overall, the first insertion resulted in successful ventilation during 294 interventions for an overall proportion of first-pass success ranging between 57.1% and 72.1%. CONCLUSION Proportions of successful ventilation and ETC first-pass success are lower than those reported in the literature with supraglottic airway devices. The reasons explaining these lower rates and their impact on patient-centered outcomes need to be studied.
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Affiliation(s)
| | | | | | - Marcel Emond
- Centre de recherche du CHU de Québec, Université Laval; VITAM - Centre de recherche en santé durable de l'Université Laval; Département de médecine d'urgence, Institut de Cardiologie et de Pneumologie de l'Université Laval; Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
| | - Jessica Harrisson
- Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
| | - Sébastien Robert
- Département de médecine d'urgence, Institut de Cardiologie et de Pneumologie de l'Université Laval
| | - Nicolas Capolla-Daneau
- Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
| | | | | | - Eric Mercier
- Centre de recherche du CHU de Québec, Université Laval; VITAM - Centre de recherche en santé durable de l'Université Laval; Département de médecine d'urgence, Institut de Cardiologie et de Pneumologie de l'Université Laval; Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
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Lyng JW, Baldino KT, Braude D, Fritz C, March JA, Peterson TD, Yee A. Prehospital Supraglottic Airways: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:32-41. [PMID: 35001830 DOI: 10.1080/10903127.2021.1983680] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Supraglottic airway (SGA) devices provide effective conduits for oxygenation and ventilation and may offer protection from gastric aspiration. SGA devices are widely used by EMS clinicians as both rescue and primary airway management devices. While in common use for more than four decades, major developments in SGA education, science, and technology have influenced clinical strategies of SGA insertion and use in prehospital airway management for patients of all ages. NAEMSP recommends:SGAs have utility as a primary or secondary EMS airway intervention. EMS agencies should select SGA strategies that best suit available resources and local clinician skillset, as well as the nature of their clinical practice setting.EMS agencies that perform endotracheal intubation must also equip their clinicians with SGA devices and ensure adequate training and competence.In select situations, drug-assisted airway management may be used by properly credentialed EMS clinicians to facilitate SGA insertion.Confirmation of initial and continuous SGA placement using waveform capnography is strongly encouraged as a best practice.When it is functioning properly, EMS clinicians should refrain from converting an SGA to an endotracheal tube. The decision to convert an SGA to an endotracheal tube must consider the patient's condition, the effectiveness of SGA ventilations, and the clinical context and course of initial SGA insertionSGA training, competency, and clinical use must be continuously evaluated by EMS agencies using focused quality management programs.
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Alenazi A, Alotaibi B, Saleh N, Alshibani A, Alharbi M, Aljerian N, Alharthy N, Alsomali S. Perception and success rate of using advanced airway management by hospital-based paramedics in the Kingdom of Saudi Arabia. Br Paramed J 2021; 6:24-30. [PMID: 34970079 DOI: 10.29045/14784726.2021.12.6.3.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective The study aimed to measure the success rate of pre-hospital tracheal intubation (TI) and supraglottic airway devices (SADs) performed by paramedics for adult patients and to assess the perception of paramedics of advanced airway management. Method The study consisted of two phases: phase 1 was a retrospective analysis to assess the TI and SADs' success rates when applied by paramedics for adult patients aged >14 years from 2012 to 2017, and phase 2 was a distributed questionnaire to assess paramedics' perception of advanced airway management. Result In phase 1, 24 patients met our inclusion criteria. Sixteen (67%) patients had TI, of whom five had failed TI but then were successfully managed using SADs. The TI success rate was 69% from the first two attempts compared to SADs (100% from first attempt). In phase 2, 63/90 (70%) paramedics responded to the questionnaire, of whom 60 (95%) completed it. Forty-eight (80%) paramedics classified themselves to be moderately or very competent with advanced airway management. However, most of them (80%) performed only 1-5 TIs or SADs a year. Conclusion Hospital-based paramedics (i.e. paramedics who are working at hospitals and not in the ambulance service, and who mostly respond to small restricted areas in Saudi Arabia) handled few patients requiring advanced airway management and had a higher competency level with SADs than with TI. The study findings could be impacted by the low sample size. Future research is needed on the success rate and impact on outcomes of using pre-hospital advanced airway management, and on the challenges of mechanical ventilation use during interfacility transfer.
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Affiliation(s)
- Amani Alenazi
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS)
| | | | | | | | - Meshal Alharbi
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS)
| | | | - Nesrin Alharthy
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS)
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Panchal AR, Berg KM, Hirsch KG, Kudenchuk PJ, Del Rios M, Cabañas JG, Link MS, Kurz MC, Chan PS, Morley PT, Hazinski MF, Donnino MW. 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2019; 140:e881-e894. [PMID: 31722552 DOI: 10.1161/cir.0000000000000732] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The fundamentals of cardiac resuscitation include the immediate provision of high-quality cardiopulmonary resuscitation combined with rapid defibrillation (as appropriate). These mainstays of therapy set the groundwork for other possible interventions such as medications, advanced airways, extracorporeal cardiopulmonary resuscitation, and post-cardiac arrest care, including targeted temperature management, cardiorespiratory support, and percutaneous coronary intervention. Since 2015, an increased number of studies have been published evaluating some of these interventions, requiring a reassessment of their use and impact on survival from cardiac arrest. This 2019 focused update to the American Heart Association advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest. It includes revised recommendations for all 3 areas, including the choice of advanced airway devices and strategies during cardiac arrest (eg, bag-mask ventilation, supraglottic airway, or endotracheal intubation), the training and retraining required, the administration of standard-dose epinephrine, and the decisions involved in the application of extracorporeal cardiopulmonary resuscitation and its potential impact on cardiac arrest survival.
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8
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Wang HE, Schmicker RH, Daya MR, Stephens SW, Idris AH, Carlson JN, Colella MR, Herren H, Hansen M, Richmond NJ, Puyana JCJ, Aufderheide TP, Gray RE, Gray PC, Verkest M, Owens PC, Brienza AM, Sternig KJ, May SJ, Sopko GR, Weisfeldt ML, Nichol G. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA 2018; 320:769-778. [PMID: 30167699 PMCID: PMC6583103 DOI: 10.1001/jama.2018.7044] [Citation(s) in RCA: 239] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Emergency medical services (EMS) commonly perform endotracheal intubation (ETI) or insertion of supraglottic airways, such as the laryngeal tube (LT), on patients with out-of-hospital cardiac arrest (OHCA). The optimal method for OHCA advanced airway management is unknown. OBJECTIVE To compare the effectiveness of a strategy of initial LT insertion vs initial ETI in adults with OHCA. DESIGN, SETTING, AND PARTICIPANTS Multicenter pragmatic cluster-crossover clinical trial involving EMS agencies from the Resuscitation Outcomes Consortium. The trial included 3004 adults with OHCA and anticipated need for advanced airway management who were enrolled from December 1, 2015, to November 4, 2017. The final date of follow-up was November 10, 2017. INTERVENTIONS Twenty-seven EMS agencies were randomized in 13 clusters to initial airway management strategy with LT (n = 1505 patients) or ETI (n = 1499 patients), with crossover to the alternate strategy at 3- to 5-month intervals. MAIN OUTCOMES AND MEASURES The primary outcome was 72-hour survival. Secondary outcomes included return of spontaneous circulation, survival to hospital discharge, favorable neurological status at hospital discharge (Modified Rankin Scale score ≤3), and key adverse events. RESULTS Among 3004 enrolled patients (median [interquartile range] age, 64 [53-76] years, 1829 [60.9%] men), 3000 were included in the primary analysis. Rates of initial airway success were 90.3% with LT and 51.6% with ETI. Seventy-two hour survival was 18.3% in the LT group vs 15.4% in the ETI group (adjusted difference, 2.9% [95% CI, 0.2%-5.6%]; P = .04). Secondary outcomes in the LT group vs ETI group were return of spontaneous circulation (27.9% vs 24.3%; adjusted difference, 3.6% [95% CI, 0.3%-6.8%]; P = .03); hospital survival (10.8% vs 8.1%; adjusted difference, 2.7% [95% CI, 0.6%-4.8%]; P = .01); and favorable neurological status at discharge (7.1% vs 5.0%; adjusted difference, 2.1% [95% CI, 0.3%-3.8%]; P = .02). There were no significant differences in oropharyngeal or hypopharyngeal injury (0.2% vs 0.3%), airway swelling (1.1% vs 1.0%), or pneumonia or pneumonitis (26.1% vs 22.3%). CONCLUSIONS AND RELEVANCE Among adults with OHCA, a strategy of initial LT insertion was associated with significantly greater 72-hour survival compared with a strategy of initial ETI. These findings suggest that LT insertion may be considered as an initial airway management strategy in patients with OHCA, but limitations of the pragmatic design, practice setting, and ETI performance characteristics suggest that further research is warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02419573.
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Affiliation(s)
- Henry E. Wang
- Department of Emergency Medicine, University of Texas Health Science Center at Houston
- Department of Emergency Medicine, University of Alabama at Birmingham
| | - Robert H. Schmicker
- Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle
| | - Mohamud R. Daya
- Department of Emergency Medicine, Oregon Health and Science University, Portland
| | | | - Ahamed H. Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Jestin N. Carlson
- Department of Emergency Medicine, Saint Vincent Hospital, Allegheny Health Network, Erie, Pennsylvania
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Heather Herren
- Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle
| | - Matthew Hansen
- Department of Emergency Medicine, Oregon Health and Science University, Portland
| | - Neal J. Richmond
- MedStar Mobile Healthcare, Fort Worth, Texas
- currently with Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, Texas
| | | | - Tom P. Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Randal E. Gray
- Department of Emergency Medicine, University of Alabama at Birmingham
| | - Pamela C. Gray
- Department of Emergency Medicine, University of Alabama at Birmingham
| | | | - Pamela C. Owens
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | | | | | - Susanne J. May
- Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle
| | - George R. Sopko
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Myron L. Weisfeldt
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Graham Nichol
- Departments of Emergency Medicine and Medicine, Harborview Center for Prehospital Emergency Care, University of Washington, Seattle
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Warnecke T, Dobbermann M, Becker T, Bernhard M, Hinkelbein J. [Performance of prehospital emergency anesthesia and airway management : An online survey]. Anaesthesist 2018; 67:654-663. [PMID: 29959500 DOI: 10.1007/s00101-018-0466-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The goal of rapid sequence induction (RSI) in cases of emergency situations is to secure the airway as quickly as possible to prevent pulmonary aspiration of gastric contents; however, the technique itself is not standardized. For example, the choice of drugs, application of cricoid pressure and the patient position remain controversial. A survey of emergency medical services (EMS) physicians throughout Germany was carried out to assess the different RSI techniques used and with respect to complying with the national guidelines for emergency airway management anesthesia and local standard operating procedures (SOP). MATERIAL AND METHODS Between 1 April 2017 and 31 May 2017, EMS medical directors in Germany were contacted and asked to distribute a 28-question online questionnaire to local EMS physicians. Of the questions 26 were multiple choice and 2 with plain text. After 6 weeks an e‑mail reminder was sent. In addition, the survey was distributed via social media to EMS physicians. RESULTS In total the survey was opened 2314 times and 1074 completed responses were received (completion rate 46%). Most of the participants were male (78%) and anesthesiologists (70%) and only one quarter had a local SOP for RSI. The most frequently used muscle relaxant was succinylcholine (62%) and over half of the participants reported using cricoid pressure (57%). There was a distinction between the specialist disciplines in the selection of drugs. Propofol was used most by anesthesiologists, while the others still used etomidate on a larger scale. Nearly 100% could fall back on supraglottic devices (one third laryngeal mask, two thirds laryngeal tube) but only 32.8% with the recommended esophageal drainage. A video laryngoscope was available to 51% of all EMS physicians surveyed. CONCLUSION The results of the survey demonstrate heterogeneity in RSI techniques used by EMS physicians in Germany. Medical equipment and safe care practices, such as labeling of syringes varied considerably between different service areas. The recommendations of the S1 national guidelines on emergency airway management and anesthesia should be adhered to together with the implementation of local SOPs.
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Affiliation(s)
- T Warnecke
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Evangelisches Klinikum Niederrhein, Fahrner Straße 133, 47169, Duisburg, Deutschland.
| | - M Dobbermann
- Klinik für Anästhesie, Operative Intensiv- und Palliativmedizin, Städtisches Klinikum Solingen gGmbH, Akademisches Lehrkrankenhaus der Universität zu Köln, Solingen, Deutschland
| | - T Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.,Arbeitsgruppe "Trauma- und Schockraummanagement" des Arbeitskreises Notfallmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, Nürnberg, Deutschland
| | - J Hinkelbein
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR), Köln, Deutschland
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Vithalani VD, Vlk S, Davis SQ, Richmond NJ. Unrecognized failed airway management using a supraglottic airway device. Resuscitation 2017; 119:1-4. [PMID: 28750882 DOI: 10.1016/j.resuscitation.2017.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/29/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND 911 Emergency Medical Services (EMS) systems utilize supraglottic devices for either primary advanced airway management, or for airway rescue following failed attempts at direct laryngoscopy endotracheal intubation. There is, however, limited data on objective confirmation of supraglottic airway placement in the prehospital environment. Furthermore, the ability of EMS field providers to recognize a misplaced airway is unknown. METHODS Retrospective review of patients who underwent airway management using the King LTS-D supraglottic airway in a large urban EMS system, between 3/1/15-9/30/2015. Subjective success was defined as documentation of successful airway placement by the EMS provider. Objective success was confirmed by review of waveform capnography, with the presence of a 4-phase waveform greater than 5mmHg. Sensitivity and specificity of the field provider's assessment of success were then calculated. RESULTS A total of 344 supraglottic airway attempts were reviewed. No patients met obvious death criteria. 269 attempts (85.1%) met criteria for both subjective and objective success. 19 attempts (5.6%) were recognized failures by the EMS provider. 47 (13.8%) airways were misplaced but unrecognized by the EMS provider. 4 attempts (1.2%) were correctly placed but misidentified as failures, leading to the unnecessary removal and replacement of the airway. Sensitivity of the provider's assessment was 98.5%; specificity was 28.7%. CONCLUSION The use of supraglottic airway devices results in unrecognized failed placement. Appropriate utilization and review of waveform capnography may remedy a potential blind-spot in patient safety, and systemic monitoring/feedback processes may therefore be used to prevent unrecognized misplaced airways.
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Affiliation(s)
- Veer D Vithalani
- Office of the Medical Director, Emergency Physicians Advisory Board, MedStar Mobile Healthcare, Area Metropolitan EMS Authority, 2900 Alta Mere Drive, Fort Worth, TX 76116, United States.
| | - Sabrina Vlk
- Office of the Medical Director, Emergency Physicians Advisory Board, MedStar Mobile Healthcare, Area Metropolitan EMS Authority, 2900 Alta Mere Drive, Fort Worth, TX 76116, United States.
| | - Steven Q Davis
- Office of the Medical Director, Emergency Physicians Advisory Board, MedStar Mobile Healthcare, Area Metropolitan EMS Authority, 2900 Alta Mere Drive, Fort Worth, TX 76116, United States.
| | - Neal J Richmond
- Office of the Medical Director, Emergency Physicians Advisory Board, MedStar Mobile Healthcare, Area Metropolitan EMS Authority, 2900 Alta Mere Drive, Fort Worth, TX 76116, United States.
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11
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Driver BE, Plummer D, Heegaard W, Reardon RF. Tracheal Malplacement of the King LT Airway May Be an Important Cause of Prehospital Device Failure. J Emerg Med 2016; 51:e133-e135. [DOI: 10.1016/j.jemermed.2016.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022]
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12
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Insertion Success of the Laryngeal Tube in Emergency Airway Management. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3619159. [PMID: 27642595 PMCID: PMC5013225 DOI: 10.1155/2016/3619159] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/26/2016] [Indexed: 12/12/2022]
Abstract
Background. Emergency airway management (AM) is a priority when resuscitating critically ill or severely injured patients. The goal of this study was to determine the success rates of LT insertion during AM. Methods. Studies that included LT first-pass insertion (FPI) and overall-pass insertion (OPI) success by emergency medical services and in-hospital providers performing AM for emergency situations as well as for scheduled surgery published until July 2014 were searched systematically in Medline. Results. Data of 36 studies (n = 1,897) reported a LT FPI success by physicians of 82.5% with an OPI success of 93.6% (p < 0.001). A cumulative analysis of all 53 studies (n = 3,600) led to FPI and OPI success of 80.1% and 92.6% (p < 0.001), respectively. The results of 26 studies (n = 2,159) comparing the LT with the laryngeal mask airway (LMA) demonstrated a FPI success of 77.0 versus 78.7% (p = 0.36) and an OPI success of 92.2 versus 97.7% (p < 0.001). Conclusion. LT insertion failed in the first attempt in one out of five patients, with an overall failure rate in one out of 14 patients. When compared with the LT, the LMA had a cumulative 5.5% better OPI success rate.
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Myers LA, Gallet CG, Kolb LJ, Lohse CM, Russi CS. Determinants of Success and Failure in Prehospital Endotracheal Intubation. West J Emerg Med 2016; 17:640-7. [PMID: 27625734 PMCID: PMC5017854 DOI: 10.5811/westjem.2016.6.29969] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/04/2016] [Accepted: 06/13/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction This study aimed to identify factors associated with successful endotracheal intubation (ETI) by a multisite emergency medical services (EMS) agency. Methods We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth). We analyzed patient and EMS factors affecting ETI. Results During 12,527 emergent ambulance responses, 200 intubation attempts were made in 150 patients. Intubation was successful in 113 (75%). A crew with paramedics was more than three times as likely to achieve successful intubation as a paramedic/emergency medical technician-Basic crew (odds ratio [OR], 3.30; p=0.03). A small tube (≤7.0 inches) was associated with a more than 4-fold increased likelihood of successful ETI compared with a large tube (≥7.5 inches) (OR, 4.25; p=0.01). After adjustment for these features, compared with little or no view of the glottis, a partial or entire view of the glottis was associated with a nearly 13-fold (OR, 12.98; p=0.001) and a nearly 40-fold (OR, 39.78; p<0.001) increased likelihood of successful intubation, respectively. Conclusion Successful ETI was more likely to be accomplished when a paramedic was partnered with another paramedic, when some or all of the glottis was visible and when a smaller endotracheal tube was used.
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Affiliation(s)
| | | | - Logan J Kolb
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
| | - Christine M Lohse
- Mayo Clinic, Division of Biomedical Statistics and Informatics, Rochester, Minnesota
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van Tulder R, Schriefl C, Roth D, Stratil P, Thalhammer M, Wieczorek H, Lausch F, Zajicek A, Haidvogel J, Sebald D, Schreiber W, Sterz F, Laggner A. Laryngeal Tube Practice in a Metropolitan Ambulance Service: A Five-year Retrospective Observational Study (2009–2013). PREHOSP EMERG CARE 2016; 24:434-440. [DOI: 10.3109/10903127.2015.1129473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hilton MT, Wayne M, Martin-Gill C. Impact of System-Wide King LT Airway Implementation on Orotracheal Intubation. PREHOSP EMERG CARE 2016; 20:570-7. [DOI: 10.3109/10903127.2016.1163446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wang HE, Prince DK, Stephens SW, Herren H, Daya M, Richmond N, Carlson J, Warden C, Colella MR, Brienza A, Aufderheide TP, Idris AH, Schmicker R, May S, Nichol G. Design and implementation of the Resuscitation Outcomes Consortium Pragmatic Airway Resuscitation Trial (PART). Resuscitation 2016; 101:57-64. [PMID: 26851059 PMCID: PMC4792760 DOI: 10.1016/j.resuscitation.2016.01.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/07/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
Airway management is an important component of resuscitation from out-of-hospital cardiac arrest (OHCA). The optimal approach to advanced airway management is unknown. The Pragmatic Airway Resuscitation Trial (PART) will compare the effectiveness of endotracheal intubation (ETI) and Laryngeal Tube (LT) insertion upon 72-h survival in adult OHCA. Encompassing United States Emergency Medical Services agencies affiliated with the Resuscitation Outcomes Consortium (ROC), PART will use a cluster-crossover randomized design. Participating subjects will include adult, non-traumatic OHCA requiring bag-valve-mask ventilation. Trial interventions will include (1) initial airway management with ETI and (2) initial airway management with LT. The primary and secondary trial outcomes are 72-h survival and return of spontaneous circulation. Additional clinical outcomes will include airway management process and adverse events. The trial will enroll a total of 3000 subjects. Results of PART may guide the selection of advanced airway management strategies in OHCA.
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Affiliation(s)
- Henry E Wang
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States.
| | - David K Prince
- Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA, United States.
| | - Shannon W Stephens
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States.
| | - Heather Herren
- Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA, United States.
| | - Mohamud Daya
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States.
| | | | - Jestin Carlson
- St Vincent's Medical Center, Erie, PA, United States; Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Craig Warden
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States.
| | - M Riccardo Colella
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Ashley Brienza
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Ahamed H Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - Robert Schmicker
- Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA, United States.
| | - Susanne May
- Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA, United States.
| | - Graham Nichol
- Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA, United States.
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Roth D, Hafner C, Aufmesser W, Hudabiunigg K, Wutti C, Herkner H, Schreiber W. Safety and feasibility of the laryngeal tube when used by EMTs during out-of-hospital cardiac arrest. Am J Emerg Med 2015; 33:1050-5. [PMID: 25957625 DOI: 10.1016/j.ajem.2015.04.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Ventilation is still one key element of advanced life support. Emergency medical technicians (EMTs) without training in advanced airway management usually use bag valve mask ventilation (BVM). Bag valve mask ventilation requires proper training and yet may be difficult and ineffective. Supraglottic airway devices, such as the laryngeal tube (LT), have been proposed as alternatives. Safety and feasibility are unclear if used by EMTs with limited training only. We compared efficacy of the LT to BVM for out-of-hospital cardiac arrest in a primarily volunteer-based emergency medical services. METHODS This is a prospective multicenter observational cohort study. We compared safety (injuries and regurgitation) and feasibility (successful ventilation) in patients who received BVM, LT, or fallback to BVM after LT and controlled for potential confounders using logistic regression. RESULTS A total of 517 cases were documented, 395 (76.7%) with LT, 74 (14.4%) with BVM, and 48 (9.3%) where EMTs fell back from LT to BVM. There was no difference between groups regarding demographics (71 ± 17 years; 37% female) and initial rhythm (44% shockable). Placement of LT at first attempt was possible in 300 cases (76%), and at second attempt, in 91 cases (23%). Compared to BVM (22 cases [30%]), ventilation was more frequently successful with LT in 367 cases (93%; adjusted risk ratio, 3.1 [95% confidence interval, 1.3-7.1]; P < .01) and less successful with LT to BVM in 7 cases (15%; 0.3 [0.1-0.7]; P = .01). Five injuries (1.3%) were documented. Regurgitation was observed 8 (11%), 22 (6%; P < .01), and 8 times (17%; P < .01), respectively. CONCLUSIONS Use of the LT during out-of-hospital cardiac arrest by EMTs with only basic training appears safe and feasible. Compared to BVM, success rates were higher. Injuries were relatively rare.
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Affiliation(s)
- Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christina Hafner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; Department of Anaesthesiology and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| | - Wolfgang Schreiber
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; Austrian Red Cross, Vienna, Austria
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Martin-Gill C, Prunty HA, Ritter SC, Carlson JN, Guyette FX. Risk factors for unsuccessful prehospital laryngeal tube placement. Resuscitation 2015; 86:25-30. [DOI: 10.1016/j.resuscitation.2014.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 10/20/2014] [Accepted: 10/20/2014] [Indexed: 11/28/2022]
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Bernhard M, Beres W, Timmermann A, Stepan R, Greim CA, Kaisers U, Gries A. Prehospital airway management using the laryngeal tube. Anaesthesist 2014; 63:589-96. [DOI: 10.1007/s00101-014-2348-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Diggs LA, Yusuf JE(W, De Leo G. An update on out-of-hospital airway management practices in the United States. Resuscitation 2014; 85:885-92. [DOI: 10.1016/j.resuscitation.2014.02.032] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 02/13/2014] [Accepted: 02/28/2014] [Indexed: 11/25/2022]
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Abstract
Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome. In studies demonstrating poor outcomes related to prehospital-attempted endotracheal intubation (ETI), both training and skill level of the provider are usually often low. Research supports a relationship between the number of intubation experiences and ETI success. National standards for certification of emergency medicine provider are in general too low to guarantee good success rate in emergency airway management by paramedics and physicians. Some paramedic training programs require more intense airway training above the national standard and some EMS systems in Europe staff their system with anesthesia providers instead. ETI remains the cornerstone of definitive prehospital airway management, However, ETI is not without risk and outcomes data remains controversial. Many systems may benefit from more input and guidance by the anesthesia department, which have higher volumes of airway management procedures and extensive training and experience not just with training of airway management but also with different airway management techniques and adjuncts.
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Affiliation(s)
- PE Jacobs
- University of Washington/Harborview Medical Center, Box 359724, 325 Ninth Avenue, Seattle, WA 98104
| | - A Grabinsky
- University of Washington/Harborview Medical Center, Box 359724, 325 Ninth Avenue, Seattle, WA 98104
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Frascone RJ, Wewerka SS, Burnett AM, Griffith KR, Salzman JG. Supraglottic airway device use as a primary airway during rapid sequence intubation. Air Med J 2013; 32:93-7. [PMID: 23452368 DOI: 10.1016/j.amj.2012.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 04/30/2012] [Accepted: 06/24/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study compared first-attempt placement success rates of the King LTS-D as a primary airway for patients requiring medication-assisted airway management (MAAM) against historical controls. SETTING Rotor-wing division of a single critical care transportation company METHODS 53 providers (RNs/EMT-P) consented to participation and were trained in the use of the King LTS-D. All patients in need of MAAM per agency treatment guidelines were screened for inclusion and exclusion criteria. After each placement attempt, providers completed data collection via telephone. The primary endpoint was comparison of first-attempt placement success rate between the King LTS-D and historical control endotracheal intubation (ETI) MAAM patients. Overall placement success, time to placement, pre- and post-placement SaO2, ETCO2 at 2 minutes after placement, and complications were also analyzed. RESULTS 38 patients received rapid sequence intubation with the King LTS-D by 23 of 58 consented providers. First-attempt success rate was 76% (29/38), with an overall success rate of 84% (32/38). The primary endpoint analysis showed no difference in first-attempt success rate between historical control ETI MAAM data and King LTS-D (71% vs 76%; OR = 0.1.34 [95% CI Intubation time to insertion was 26 seconds (IQR = 12-46). Pre- and post-insertion SaO(1)2 values were 88.9 ± 12.6% and 92.1 ± 12.7%, respectively. Mean ETCO2 at 2 minutes after placement was 34.8 ± 4.0. Vomit in the patient's airway was the most frequently reported complication (46%). CONCLUSION Success rates with the King LTS-D were not significantly different from historical control ETI data. Time to placement was comparable to previous reports.
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Ostermayer DG, Gausche-Hill M. Supraglottic Airways: The History and Current State of Prehospital Airway Adjuncts. PREHOSP EMERG CARE 2013; 18:106-15. [DOI: 10.3109/10903127.2013.825351] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Manifold CA, Davids N, Villers LC, Wampler DA. Capnography for the nonintubated patient in the emergency setting. J Emerg Med 2013; 45:626-32. [PMID: 23871325 DOI: 10.1016/j.jemermed.2013.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 01/28/2013] [Accepted: 05/01/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Multiple studies illustrate the benefits of waveform capnography in the nonintubated patient. This type of monitoring is routinely used by anesthesia providers to recognize ventilation issues. Its role in the administration of deep sedation is well defined. Prehospital providers embrace the ease and benefit of monitoring capnography. Currently, few community-based emergency physicians utilize capnography with the nonintubated patient. OBJECTIVE This article will identify clinical areas where monitoring end-tidal carbon dioxide is beneficial to the emergency provider and patient. DISCUSSION Capnography provides real-time data to aid in the diagnosis and patient monitoring for patient states beyond procedural sedation and bronchospasm. Capnographic changes provide valuable information in such processes as diabetic ketoacidosis, seizures, pulmonary embolism, and malignant hyperthermia. CONCLUSIONS Capnography is a quick, low-cost method of enhancing patient safety with the potential to improve the clinician's diagnostic power.
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Affiliation(s)
- Craig A Manifold
- Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Länkimäki S, Alahuhta S, Kurola J. Feasibility of a laryngeal tube for airway management during cardiac arrest by first responders. Resuscitation 2013; 84:446-9. [DOI: 10.1016/j.resuscitation.2012.08.326] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 07/26/2012] [Accepted: 08/20/2012] [Indexed: 10/27/2022]
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Gruber C, Nabecker S, Wohlfarth P, Ruetzler A, Roth D, Kimberger O, Fischer H, Frass M, Ruetzler K. Evaluation of airway management associated hands-off time during cardiopulmonary resuscitation: a randomised manikin follow-up study. Scand J Trauma Resusc Emerg Med 2013; 21:10. [PMID: 23433462 PMCID: PMC3598524 DOI: 10.1186/1757-7241-21-10] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/19/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Airway management is an important component of cardiopulmonary resuscitation (CPR). Recent guidelines recommend keeping any interruptions of chest compressions as short as possible and not lasting more than 10 seconds. Endotracheal intubation seems to be the ideal method for establishing a secure airway by experienced providers, but emergency medical technicians (EMT) often lack training and practice. For the EMTs supraglottic devices might serve as alternatives. METHODS 40 EMTs were trained in a 1-hour standardised audio-visual lesson to handle six different airway devices including endotracheal intubation, Combitube, EasyTube, I-Gel, Laryngeal Mask Airway and Laryngeal tube. EMTs performances were evaluated immediately after a brief practical demonstration, as well as after 1 and 3 months without any practice in between, in a randomised order. Hands-off time was pair-wise compared between airway devices using a repeated-measures mixed-effects model. RESULTS Overall mean hands-off time was significantly (p<0.01) lower for Laryngeal tube (6.1s; confidence interval 5.2-6.9s), Combitube (7.9s; 95% CI 6.9-9.0s), EasyTube (8.8s; CI 7.3-10.3s), LMA (10.2s; CI 8.6-11.7s), and I-Gel (11.9s; CI 10.2-13.7s) compared to endotracheal intubation (39.4s; CI 34.0-44.9s). Hands-off time was within the recommended limit of 10s for Combitube, EasyTube and Laryngeal tube after 1 month and for all supraglottic devices after 3 months without any training, but far beyond recommended limits in all three evaluations for endotracheal intubation. CONCLUSION Using supraglottic airway devices, EMTs achieved a hands-off time within the recommended time limit of 10s, even after three months without any training or practice. Supraglottic airway devices are recommended tools for EMTs with lack of experience in advanced airway management.
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Affiliation(s)
- Christina Gruber
- Department of General Anaesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
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Nelson JG, Wewerka SS, Woster CM, Burnett AM, Salzman JG, Frascone RJ. Evaluation of the Storz CMAC®, Glidescope® GVL, AirTraq®, King LTS-D™, and direct laryngoscopy in a simulated difficult airway. Am J Emerg Med 2013; 31:589-92. [PMID: 23347722 DOI: 10.1016/j.ajem.2012.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 10/08/2012] [Accepted: 10/10/2012] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare first-attempt and overall success rates and success rates in relation to placement time among 5 different airway management devices: Storz CMAC, Glidescope GVL, AirTraq, King LTS-D, and direct laryngoscopy (DL). METHODS Emergency medical technician basic (EMT-B), EMT-paramedics (EMT-P), and emergency medicine residents and staff physicians placed each of the 5 devices in a random order into an AirSim (TruCorp, Belfast, UK) part-task training manikin. The difficult airway scenario was created by fixing the manikin head to a stationary object and introducing simulated emesis into the hypopharynx. First-attempt and overall success and success in relation to placement time were compared. Provider feedback about device performance was also evaluated. RESULTS Ninety-four providers (16 EMT-basics, 54 EMT-paramedics, and 24 emergency department doctors of medicine) consented to participation. First-attempt and overall success rates for DL, King LTS-D, GVL, and CMAC were not statistically different. Compared with DL, the AirTraq was 96% less likely to be placed successfully (odds ratio, 0.04; 95% confidence interval [CI], 0.01-0.14). When time was factored into the model, the odds of successful placement of the King LTS-D were higher compared with DL (hazard ratio [HR], 1.80; 95% CI, 1.34-2.42) and lower for GVL (HR, 0.59; 95% CI, 0.44-0.80) and AirTraq (HR, 0.228; 95% CI, 0.16-0.325). Providers ranked the CMAC first in terms of performance and preference for use in their practice setting. CONCLUSION Overall success rates for DL, King-LTS-D, and both video laryngoscope systems were not different. When time was factored into the model, the King LTS-D was more likely to be placed successfully.
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Affiliation(s)
- Jessie G Nelson
- Department of Emergency Medicine, Regions Hospital, St Paul, MN 55101, USA
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Jensen JL, Walker M, LeRoux Y, Carter A. Chest Compression Fraction in Simulated Cardiac Arrest Management by Primary Care Paramedics: King Laryngeal Tube Airway Versus Basic Airway Management. PREHOSP EMERG CARE 2013; 17:285-90. [DOI: 10.3109/10903127.2012.744784] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jan L. Jensen
- From Emergency Health Services, Quality and Learning (JLJ, MW),
Dartmouth, Nova Scotia, Canada; the Division of EMS, QEII Health Sciences Centre, Dalhousie University (JLJ),
Halifax, Nova Scotia, Canada; the Medicine School, Dalhousie University (YL),
Halifax, Nova Scotia, Canada; Emergency Health Services (AC), Dartmouth,
Nova Scotia, Canada; and the Department of Emergency Medicine, Dalhousie University (AC),
Halifax, Nova Scotia, Canada
| | - Mark Walker
- From Emergency Health Services, Quality and Learning (JLJ, MW),
Dartmouth, Nova Scotia, Canada; the Division of EMS, QEII Health Sciences Centre, Dalhousie University (JLJ),
Halifax, Nova Scotia, Canada; the Medicine School, Dalhousie University (YL),
Halifax, Nova Scotia, Canada; Emergency Health Services (AC), Dartmouth,
Nova Scotia, Canada; and the Department of Emergency Medicine, Dalhousie University (AC),
Halifax, Nova Scotia, Canada
| | - Yves LeRoux
- From Emergency Health Services, Quality and Learning (JLJ, MW),
Dartmouth, Nova Scotia, Canada; the Division of EMS, QEII Health Sciences Centre, Dalhousie University (JLJ),
Halifax, Nova Scotia, Canada; the Medicine School, Dalhousie University (YL),
Halifax, Nova Scotia, Canada; Emergency Health Services (AC), Dartmouth,
Nova Scotia, Canada; and the Department of Emergency Medicine, Dalhousie University (AC),
Halifax, Nova Scotia, Canada
| | - Alix Carter
- From Emergency Health Services, Quality and Learning (JLJ, MW),
Dartmouth, Nova Scotia, Canada; the Division of EMS, QEII Health Sciences Centre, Dalhousie University (JLJ),
Halifax, Nova Scotia, Canada; the Medicine School, Dalhousie University (YL),
Halifax, Nova Scotia, Canada; Emergency Health Services (AC), Dartmouth,
Nova Scotia, Canada; and the Department of Emergency Medicine, Dalhousie University (AC),
Halifax, Nova Scotia, Canada
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Cone DC. Are alternative airway devices beneficial in out-of-hospital cardiac arrest? Resuscitation 2012; 83:275-6. [DOI: 10.1016/j.resuscitation.2011.12.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 12/14/2011] [Indexed: 11/28/2022]
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Bullock R, Foreman M, Conterato M. Temperature and Trauma in Accidental Hypothermia. Ther Hypothermia Temp Manag 2011; 1:179-83. [DOI: 10.1089/ther.2011.1511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ross Bullock
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael Foreman
- Department of Surgery, Baylor University Medical Center, Dallas, Texas
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