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Morton S, Keane S, O'Meara M. Pediatric Intubations in a Semiurban Helicopter Emergency Medicine Service: A Retrospective Review. Air Med J 2024; 43:106-110. [PMID: 38490772 DOI: 10.1016/j.amj.2023.10.007] [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: 08/14/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Although a small proportion of helicopter emergency medical service (HEMS) missions are for pediatric patients, it is recognized that children do present unique challenges. This case series aims to evaluate the intubation first-pass success rate in HEMS pediatric patients for both medical and trauma patients in a UK semiurban environment. METHODS A retrospective review of the computerized records system was performed from January 1, 2015, to July 31, 2022, at 1 UK HEMS. Anonymous data relating to advanced airway interventions in patients < 16 years of age were extracted. Primary analysis related to the first-pass success rate was performed; secondary analysis relating to the initial Glasgow Coma Scale (GCS) of the pediatric patients requiring prehospital anesthesia (rapid sequence induction with drugs) and first-pass success rates by clinician group was also performed. RESULTS Of the pediatric patients, 15.8% required intubation. The overall first-pass success rate for intubation (including in cardiac arrest) was 83.5%; for prehospital anesthesia (drugs administered), it was 98.4%. First-pass success rates were lowest for those under 2 years of age (45.2% without drugs and 87.5% with drugs). There was no difference between physician background in the first-pass success rate. The median GCS for pediatric prehospital anesthesia was 7 versus 5 for adults (P = .012). No children with an initial GCS of 15 had prehospital anesthesia. CONCLUSION The overall intubation first-pass success rates for pediatric patients is high at 83.5% and higher still for prehospital anesthesia (98.4%). However, it remains a rare intervention for clinicians, and children under 2 years of age require special consideration.
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Affiliation(s)
- Sarah Morton
- Essex and Herts Air Ambulance, Colchester, Essex, United Kingdom; Department of Surgery, Imperial College, London, United Kingdom.
| | - Sinead Keane
- Essex and Herts Air Ambulance, Colchester, Essex, United Kingdom
| | - Matt O'Meara
- Essex and Herts Air Ambulance, Colchester, Essex, United Kingdom
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2
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Fuller RG, Rossetto MA, Paulson MW, April MD, Ginde AA, Bebarta VS, Flarity KM, Keenan S, Schauer SG. Market Analysis of Video Laryngoscopy Equipment for the Role 1 Setting. Mil Med 2023; 188:e3482-e3487. [PMID: 37338293 DOI: 10.1093/milmed/usad189] [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: 02/12/2023] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION Airway compromise is the second leading cause of potentially preventable prehospital combat death. Endotracheal intubation (ETI) remains the most common role 1 airway intervention. Video laryngoscopy (VL) is superior to direct laryngoscopy (DL) for first-attempt intubation, especially in less-experienced providers and for trauma patients. The cost has been a major challenge in pushing VL technology far-forward; however, the cost of equipment continues to become more affordable. We conducted a market analysis of VL devices under $10,000 for possible options for role 1. MATERIALS AND METHODS We searched Google, PubMed, and the Food and Drug Administration database from August 2022 to January 2023 with a combination of several keywords to identify current VL market options under $10,000. After identifying relevant manufacturers, we then reviewed individual manufacturer or distributor websites for pricing data and system specifications. We noted several characteristics regarding VL device design for comparison. These include monitor features, size, modularity, system durability, battery life, and reusability. When necessary, we requested formal price quotes from respective companies. RESULTS We identified 17 VL options under $10,000 available for purchase, 14 of which were priced below $5,000 for individual units. Infium (n = 3) and Vimed Medical (n = 4) provided the largest number of unique models. VL options under $10,000 exist in both reusable and disposable modalities. These modalities included separate monitors as well as monitors attached to the VL handle. Disposable options, on a per-unit basis, cost less than reusable options. CONCLUSIONS Several VL options exist within our goal price point in both reusable and disposable options. Clinical studies assessing the technology performance of ETI and deliberate downselection are needed to identify the most cost-effective solution for role 1 dispersion.
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Affiliation(s)
- Robert G Fuller
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Marika A Rossetto
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Matthew W Paulson
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Colorado National Guard Medical Detachment, Buckley Space Force Base, CO 80112, USA
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO,USA
| | - Michael D April
- 40th Forward Resuscitative Surgical Detachment, Fort Carson, CO 80902, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Vikhyat S Bebarta
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
- 59th Medical Wing, JBSA Lackland, TX 78236, USA
| | - Kathleen M Flarity
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Sean Keenan
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Joint Trauma System, Defense Health Agency, JBSA Fort Sam Houston, TX, USA
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Steven G Schauer
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
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Neth MR, Lupton JR. Is there benefit to video laryngoscopy in out-of-hospital cardiac arrest? Resuscitation 2023; 185:109709. [PMID: 36717052 DOI: 10.1016/j.resuscitation.2023.109709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/29/2023]
Affiliation(s)
- Matthew R Neth
- Department of Emergency Medicine, Oregon Health and Science University, United States
| | - Joshua R Lupton
- Department of Emergency Medicine, Oregon Health and Science University, United States.
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Morton S, Dawson J, Wareham G, Broomhead R, Sherren P. The Prehospital Emergency Anaesthetic in 2022. Air Med J 2022; 41:530-535. [PMID: 36494168 DOI: 10.1016/j.amj.2022.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/28/2022] [Accepted: 08/15/2022] [Indexed: 12/14/2022]
Abstract
Prehospital emergency anesthesia (PHEA) is a commonly performed prehospital procedure with inherent risks. The processes and drug regimens behind PHEA are continually updated by prehospital teams across the country as part of their governance structure. Essex & Herts Air Ambulance has recently updated this practice by reviewing the entire process of performing PHEA. Through experiential learning in a high-volume service, audit, and a contemporary literature review, a new standard operating procedure has been developed to combat common problems, such as hypotension, associated with the more traditional methods of performing PHEA. The aim of this article was to summarize the literature behind this new standard operating procedure, systematically breaking down the core components of performing a PHEA and the rationale behind them. The key components identified in the review are indications for PHEA, airway assessment, peri-intubation oxygenation, preparation for PHEA, drug dosing, special circumstances, and failed intubation. One significant change is the drug dosage regimen; 1 μg/kg fentanyl, 2 mg/kg ketamine, and 2 mg/kg rocuronium is recommended as the main drug dosing regimen for both medical and trauma patients. Other changes include preoxygenation with a nasal cannula in addition to the nonrebreather mask, optimizing patients in the preparation phase by considering inopressors or fluid bolus and ensuring a "sterile cockpit" to control the surrounding environment to ensure the first intubation attempt is the best attempt.
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Affiliation(s)
- Sarah Morton
- Essex & Herts Air Ambulance, Flight House, Essex, United Kingdom; Department of Surgery, Imperial College, London, United Kingdom
| | - Jonathan Dawson
- Essex & Herts Air Ambulance, Flight House, Essex, United Kingdom
| | - Gaynor Wareham
- Essex & Herts Air Ambulance, Flight House, Essex, United Kingdom
| | - Robert Broomhead
- Essex & Herts Air Ambulance, Flight House, Essex, United Kingdom
| | - Peter Sherren
- Essex & Herts Air Ambulance, Flight House, Essex, United Kingdom; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
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Lepa N, Cathers A, Emmerich K, Galgon R, Jennett B, Schroeder KM, Steuerwald M. Comparison of Hyperangulated and Standard Geometry Video Laryngoscopy Tracheal Intubation for Prehospital Care in a Manikin: A Randomized Controlled Crossover Trial. Air Med J 2021; 40:317-321. [PMID: 34535238 DOI: 10.1016/j.amj.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the efficacy of hyperangulated video laryngoscopy (HAVL) versus standard geometry video laryngoscopy (SGVL) in the simulated prehospital environment using a manikin. There is consensus that video laryngoscopy (VL) can be very useful in the emergency department when difficult intubations are predicted. Emergency medical service (EMS) providers are also often faced with difficult, rapidly deteriorating airway management situations that not only involve patient and operator factors but also include challenging unique environmental factors, such as nonoptimized positions in transport vehicles (eg, helicopters and ambulances) or at ground level or entrapped positions. To our knowledge, there has never been a study purposefully investigating the efficacy of hyperangulated geometry versus standard geometry VL techniques in the prehospital environment. METHODS A single-center, randomized controlled crossover trial was performed using attending physician helicopter EMS providers. Physicians were randomized to perform 5 HAVL or SGVL intubations followed by the subsequent technique. Intubations were performed on ground level and then repeated in the helicopter with the first location also randomized. A manikin airway management trainer was used to simulate intubation in each environment. The time to intubation (primary outcome) as well as first-pass success and the Cormack-Lehane view were recorded for each attempt. Qualitative data were also obtained for physician preference and perceived difficulty. RESULTS There was no statistically significant difference in the time to intubation with HAVL versus SGVL (ground: 15.02 vs. 14.88 seconds, P = .86; helicopter: 16.11 vs. 16.14 seconds, P = .93). First-pass success was 100% for both techniques in both scenarios. More Grade 1 views were obtained with HAVL (147/150 vs. 134/150). Moreover, most physicians preferred HAVL overall and felt that HAVL required less force (9/15 grounded manikin and 10/15 helicopter manikin) and led to the best chance for first-pass success (11/15 grounded manikin and 10/15 helicopter manikin). CONCLUSION The results of this study are limited because of the static and highly favorable anatomy of a manikin versus the variability and often difficult anatomy of individual patients. Our results suggest that both techniques are efficacious when the patient is both on the ground or in the helicopter, although provider preference does seem to vary.
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Affiliation(s)
- Nicholas Lepa
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI.
| | - Andrew Cathers
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI
| | - Kevin Emmerich
- Vituity Emergency Medicine, Methodist Hospitals, Gary, IN
| | - Richard Galgon
- Department of Surgical Services, SSM Health Dean Medical Group, Saint Mary's Hospital, Janesville, WI
| | - Brian Jennett
- Iowa Methodist Emergency Medicine, Iowa Methodist Medical Center, Des Moines, IA
| | | | - Michael Steuerwald
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI
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John Doyle D, Dahaba AA, LeManach Y. Advances in anesthesia technology are improving patient care, but many challenges remain. BMC Anesthesiol 2018; 18:39. [PMID: 29653517 PMCID: PMC5899388 DOI: 10.1186/s12871-018-0504-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 02/08/2023] Open
Abstract
Although significant advances in clinical monitoring technology and clinical practice development have taken place in the last several decades, in this editorial we argue that much more still needs to be done. We begin by identifying many of the improvements in perioperative technology that have become available in recent years; these include electroencephalographic depth of anesthesia monitoring, bedside ultrasonography, advanced neuromuscular transmission monitoring systems, and other developments. We then discuss some of the perioperative technical challenges that remain to be satisfactorily addressed, such as products that incorporate poor software design or offer a confusing user interface. Finally we suggest that the journal support initiatives to help remedy this problem by publishing reports on the evaluation of medical equipment as a means to restore the link between clinical research and clinical end-users.
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Affiliation(s)
- D John Doyle
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA. .,Department of General Anesthesiology, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE, PO Box 112412, Abu Dhabi, UAE.
| | - Ashraf A Dahaba
- Priv.-Doz. Dr.med.university, Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Yannick LeManach
- Departments of Anesthesia & Health Research Methods, Evidence, and Impact, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, 1280 Main Street West Hamilton, Hamilton, ON, L8S 4L8, Canada.,Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
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Kim KN, Jeong MA, Oh YN, Kim SY, Kim JY. Efficacy of Pentax airway scope versus Macintosh laryngoscope when used by novice personnel: A prospective randomized controlled study. J Int Med Res 2017; 46:258-271. [PMID: 28835153 PMCID: PMC6011290 DOI: 10.1177/0300060517726229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine whether intubation education using the Pentax Airway Scope (AWS) in normal airways is more useful than direct laryngoscopy (Macintosh laryngoscope) in novice personnel. Methods Eleven intern doctors without intubation experience performed 60 sequential intubations with each device on a manikin and 10 sequential intubations in adult patients. The time required for successful intubation, percentage of glottic opening (POGO) score, number of intubation attempts, and number of dental injuries were analyzed for each intubation technique. Results The mean (standard deviation) time required for successful intubation decreased as the number of intubations increased and was significantly shorter with the Pentax AWS than direct laryngoscope [22.6 (7.3) vs. 29.6 (10.0) and 33.0 (8.0) vs. 44.7 (5.6) s, respectively] in both the manikin and clinical studies. The Pentax AWS was also associated with higher POGO scores than the direct laryngoscope [81.7 (8.9) vs. 55.1 (13.2) and 80.9 (9.7) vs. 49.6 (16.5), respectively] and fewer intubation attempts. Fewer dental injuries occurred with the Pentax AWS in the manikin study. Conclusions Novices performed intubation more rapidly and easily with an improved laryngeal view using the Pentax AWS. We suggest that intubation education with video laryngoscopy should be mandatory along with direct laryngoscope training.
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Affiliation(s)
- Kyu Nam Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Mi Ae Jeong
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - You Na Oh
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Soo Yeon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Ji Yoon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
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Airway Management in Disaster Response: A Manikin Study Comparing Direct and Video Laryngoscopy for Endotracheal Intubation by Prehospital Providers in Level C Personal Protective Equipment. Prehosp Disaster Med 2017; 32:352-356. [PMID: 28318455 DOI: 10.1017/s1049023x17000188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction Airway management is one of many challenges that medical providers face in disaster response operations. The use of personal protective equipment (PPE), in particular, was found to be associated with higher failure rates and a prolonged time to achieve airway control. Hypothesis/Problem The objective of this study was to determine whether video laryngoscopy could facilitate the performance of endotracheal intubation by disaster responders wearing Level C PPE. METHODS In this prospective, randomized, crossover study, a convenience sample of practicing prehospital providers were recruited. Following standardized training in PPE use and specific training in the use of airway devices, subjects in Level C PPE were observed while performing endotracheal intubation on a stock airway in a Laerdal Resusci-Anne manikin system (Laerdal Medical; Stavanger, Norway) using one of three laryngoscopic devices in randomized order: a Macintosh direct laryngoscope (Welch Allyn Inc.; New York USA), a GlideScope Ranger video laryngoscope (Verathon Medical; Bothell, Washington USA), and a King Vision video laryngoscope (King Systems; Noblesville, Indiana USA). The primary outcome was time to intubation (TTI), and the secondary outcome was participant perception of the ease of use for each device. RESULTS A total of 20 prehospital providers participated in the study: 18 (90%) paramedics and two (10%) Emergency Medical Technicians-Cardiac. Participants took significantly longer when using the GlideScope Ranger [35.82 seconds (95% CI, 32.24-39.80)] to achieve successful intubation than with the Macintosh laryngoscope [25.69 seconds (95% CI, 22.42-29.42); adj. P<.0001] or the King Vision [29.87 seconds (95% CI, 26.08-34.21); adj. P=.033], which did not significantly differ from each other (adj. P=.1017). Self-reported measures of satisfaction evaluated on a 0% to 100% visual analog scale (VAS) identified marginally greater subject satisfaction with the King Vision [86.7% (SD=76.4-92.9%)] over the GlideScope Ranger [73.0% (SD=61.9-81.8%); P=.04] and the Macintosh laryngoscope [69.9% (SD=57.9-79.7%); P=.05] prior to adjustment for multiplicity. The GlideScope Ranger and the Macintosh laryngoscope did not differ themselves (P=.65), and the differences were not statistically significant after adjustment for multiplicity (adj. P=.12 for both comparisons). CONCLUSION Use of video laryngoscopes by prehospital providers in Level C PPE did not result in faster endotracheal intubation than use of a Macintosh laryngoscope. The King Vision video laryngoscope, in particular, performed at least as well as the Macintosh laryngoscope and was reported to be easier to use. Yousif S , Machan JT , Alaska Y , Suner S . Airway management in disaster response: a manikin study comparing direct and video laryngoscopy for endotracheal intubation by prehospital providers in Level C personal protective equipment. Prehosp Disaster Med. 2017;32(4):352-356.
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Rhode MG, Vandborg MP, Bladt V, Rognås L. Video laryngoscopy in pre-hospital critical care - a quality improvement study. Scand J Trauma Resusc Emerg Med 2016; 24:84. [PMID: 27297563 PMCID: PMC4906985 DOI: 10.1186/s13049-016-0276-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Pre-hospital endotracheal intubation is challenging and repeated endotracheal intubation is associated with increased morbidity and mortality. We investigated whether the introduction of the McGrath MAC video laryngoscope as the primary device for pre-hospital endotracheal intubation could improve first-pass success rate in our anaesthesiologist-staffed pre-hospital critical care services. We also investigated the incidence of failed pre-hospital endotracheal intubation, the use of airway adjuncts and back-up devices and problems encountered using the McGrath MAC video laryngoscope. Methods Prospective quality improvement study collecting data from all adult pre-hospital endotracheal intubation performed by four anaesthesiologist-staffed pre-hospital critical care teams between December 15th 2013 and December 15th 2014. Results We registered data from 273 consecutive patients. When using the McGrath MAC video laryngoscope the overall pre-hospital endotracheal intubation first-pass success rate was 80.8 %. Following rapid sequence intubation (RSI) it was 88.9 %. This was not significantly different from previously reported first-pass success rates in our system (p = 0.27 and p = 0.41). During the last nine months of the study period the overall first-pass success rate was 80.1 (p = 0.47) but the post-RSI first-pass success rate improved to 94.4 % (0.048). The overall pre-hospital endotracheal intubation success rate with the McGrath MAC video laryngoscope was 98.9 % (p = 0.17). Gastric content, blood or secretion in the airway resulted in reduced vision when using the McGrath MAC video laryngoscope. Conclusion In this study of video laryngoscope implementation in a Scandinavian anaesthesiologist-staffed pre-hospital critical care service, overall pre-hospital endotracheal first pass success rate did not change. The post-RSI first-pass success rate was significantly higher during the last nine months of our 12-month study compared with our results from before introducing McGrath MAC video laryngoscope. The implementation of the Standard Operating Procedure and check list for pre-hospital anaesthesia during the study period may have influenced the first-pass success rate and constitutes a potential confounder. The potential limitations of the McGrath MAC video laryngoscope when there are gastric content, blood and secretions in the airways need to be further investigated before the McGrath MAC video laryngoscope can be recommended as the primary device in all pre-hospital endotracheal intubations. Electronic supplementary material The online version of this article (doi:10.1186/s13049-016-0276-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marianne Grønnebæk Rhode
- Prehospital Critical Care Service, Aarhus University Hospital, Oluf Palmes Alle 32, 1, Aarhus, N, 8200, Denmark. .,Department of Pre-hospital Critical Care Services, The Central Denmark Region, Oluf Palmes Alle 34, Aarhus, N, 8200, Denmark.
| | - Mads Partridge Vandborg
- Department of Pre-hospital Critical Care Services, The Central Denmark Region, Oluf Palmes Alle 34, Aarhus, N, 8200, Denmark.,Pre-hospital Critical Care Service, Department of Anaesthesia, Viborg Regional Hospital, Heibergs Alle 4, Viborg, 8800, Denmark
| | - Vibeke Bladt
- Department of Pre-hospital Critical Care Services, The Central Denmark Region, Oluf Palmes Alle 34, Aarhus, N, 8200, Denmark.,Pre-hospital Critical Care Service, Department and Anaesthesia, Randers Regional Hospital, Skovlyvej 1, Randers, 8930, Denmark
| | - Leif Rognås
- Prehospital Critical Care Service, Aarhus University Hospital, Oluf Palmes Alle 32, 1, Aarhus, N, 8200, Denmark.,Department of Pre-hospital Critical Care Services, The Central Denmark Region, Oluf Palmes Alle 34, Aarhus, N, 8200, Denmark
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10
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Bladt V, Vandborg MP, Rhode MG, Rognås L. Implementing videolaryngoscopy in anaesthetist-staffed pre-hospital critical care. Scand J Trauma Resusc Emerg Med 2015. [PMCID: PMC4577815 DOI: 10.1186/1757-7241-23-s2-o8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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11
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Kamiutsuri K, Okutani R, Kozawa S. Analysis of prehospital endotracheal intubation performed by emergency physicians: retrospective survey of a single emergency medical center in Japan. J Anesth 2012; 27:374-9. [PMID: 23238811 DOI: 10.1007/s00540-012-1528-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 11/18/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Advanced airway management in the prehospital setting is a serious issue in Japan because emergency medical technicians are not authorized to perform such management, whereas physicians-who are authorized to perform advanced airway management-do not usually engage in prehospital emergency medical activity. The purpose of this investigation was to investigate the success rate for endotracheal intubation (ETI) procedures and other methods of airway management employed by physicians in the prehospital setting in a single institution, as well as to examine the risk factors associated with difficult or failed endotracheal intubation (D/F ETI). METHODS We performed a retrospective survey of patients treated in the prehospital setting by emergency physicians of the Hyogo Emergency Medical Center from 2004 to 2011. Patients were divided into two groups: a cardiopulmonary arrest (CPA) group and a non-CPA group. Data on cases of D/F ETI were obtained, and risk factors for these two groups were identified using univariate and statistical analysis. RESULTS During the investigation period, ETI was attempted in the prehospital setting on 742 eligible patients; in 30 (4.04 %) of these cases, the attempts at ETI proved difficult or failed. Of those 30 patients, 13 patients received a surgical airway (attempts to provide a surgical airway failed in two patients), a blind ETI was performed in four, a video-assisted airway device was used in another four, and esophageal intubation was performed in four patients. Bag-valve ventilation alone was performed in one patient. The incidence of D/F ETI was higher in the non-CPA group than in the CPA group (6.27 vs. 2.63 %: p < 0.05). Facial or neck injury was a risk factor for D/F ETI in the prehospital setting in the CPA group (odds ratio 7.855; 95 % CI 1.754-36.293: p = 0.042). On the other hand, no risk factors for D/F ETI in the prehospital setting in the non-CPA group were identified. CONCLUSION The success rate for ETI performed by physicians in the prehospital setting at a single emergency medical center was high, and the incidence of D/F ETI was 4.31 %. The success rate for ETI in the CPA group was greater than that in the non-CPA group.
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Affiliation(s)
- Kei Kamiutsuri
- Department of Anesthesiology, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojimaku, Osaka, Japan.
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12
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Review article: Video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management? Can J Anaesth 2012; 60:184-91. [DOI: 10.1007/s12630-012-9859-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 11/27/2012] [Indexed: 02/01/2023] Open
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Abstract
Prehospital care of the trauma patient is continuing to evolve; however, the principles of airway maintenance, hemorrhage control, and appropriate resuscitative maneuvers remain central to the role of the emergency medical care provider. Recent changes in the regulations for research in emergency settings will allow randomized trials to proceed to test new devices, drugs, and resuscitative strategies in the prehospital environment. The creation of prehospital research networks will provide the appropriate infrastructure to greatly facilitate the development of new protocols and the execution of large-scale randomized trials with the potential to change current prehospital practice.
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Affiliation(s)
- Jeffrey D Kerby
- Section of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of Alabama at Birmingham, 701 19th Street South, LHRB 112, Birmingham, AL 35294-0007, USA.
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14
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Affiliation(s)
- Amir B Channa
- Department of Anesthesia, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail:
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Role of video laryngoscopy in the management of difficult intubations in the emergency department and during prehospital care. Tzu Chi Med J 2012. [DOI: 10.1016/j.tcmj.2012.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Success rates and endotracheal tube insertion times of experienced emergency physicians using five video laryngoscopes: a randomised trial in a simulated trapped car accident victim. Eur J Anaesthesiol 2012; 28:849-58. [PMID: 21986981 DOI: 10.1097/eja.0b013e32834c7c7f] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT No randomised controlled trial has yet compared different video laryngoscopes in respect of the success rates and the time taken to achieve endotracheal intubation in trapped car accident victims. OBJECTIVE The aim of the present study was to evaluate whether five video laryngoscopes facilitate tracheal intubation more quickly or more securely than conventional laryngoscopy. DESIGN Prospective, controlled, randomised crossover trial. SETTING An airway manikin was placed on the driver's seat of a compact car. Access was possible only through the opened driver's door. PARTICIPANTS Twenty-five experienced anaesthetists. INTERVENTION Tracheal intubation in a simulated trapped patient using video laryngoscopes in a typical out-of-hospital setting. MAIN OUTCOME MEASURES Times to achievement of a view of the glottis, tracheal intubation, cuff inflation, first ventilation and tracheal tube position were compared using a standard Macintosh laryngoscope or Glidescope Ranger, Storz C-MAC, Ambu-Pentax AWS, Airtraq and McGrath Series 5 video laryngoscopes in a randomised order. Wilcoxon signed-rank test and McNemar test were used for statistical analysis. A P value of less than 0.05 was considered statistically significant. RESULTS Twenty-five anaesthetists (35.1 ± 7.3 years; 16 male, nine female) with an intubation experience of 374 ± 96 intubations per year and an experience of 9.1 ± 7.3 years participated. Glottic view, tracheal intubation, cuff inflation and first ventilation were achieved most rapidly with the Macintosh laryngoscope, although the Airtraq and Pentax AWS video laryngoscopes were not significantly slower. Times were significantly longer when the Glidescope Ranger, McGrath Series 5 or Storz C-MAC video laryngoscopes were used (P < 0.05), failure to place the endotracheal tube correctly was significantly commoner with the McGrath Series 5 than with the Macintosh (P = 0.031). CONCLUSION When attempting to intubate a trapped car accident victim, video laryngoscopes provide a better view of the glottis, but some delay tracheal intubation significantly. The devices with a tube guide (Airtraq and Ambu Pentax AWS) enable tracheal intubation to be achieved significantly faster and with a lower failure rate than devices without a tube guide. No video laryngoscope outperformed direct laryngoscopy with a Macintosh laryngoscope in this simulation study.
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Butchart AG, Tjen C, Garg A, Young P. Paramedic laryngoscopy in the simulated difficult airway: comparison of the Venner A.P. Advance and GlideScope Ranger video laryngoscopes. Acad Emerg Med 2011; 18:692-8. [PMID: 21762232 DOI: 10.1111/j.1553-2712.2011.01115.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study assesses intubation times and potential trauma with two new portable video laryngoscopes, the GlideScope Ranger (GSR) and the Venner A.P. Advance (APA), in a simulated difficult prehospital airway. The GSR has a hockey stick shape and is inserted by a different (midline) technique compared with direct laryngoscopy and requires the use of a stylet. The APA has a handle similar to a direct laryngoscope, but with an angulated difficult airway blade. The APA is designed to have an intuitive insertion technique somewhat similar to that of direct laryngoscopy (lateral tongue displacement) and has a guiding mechanism that foregoes the need for a stylet. METHODS Thirty qualified paramedics received a short demonstration of each device and were asked to intubate a modified Grade III difficult laryngoscopy mannequin in a random order (closed envelope technique). Optimal view and tracheal intubation times were recorded, and potential trauma assessed by the number of additional discrete forward advances and by visual analog scale (VAS). Direct laryngoscopy was used as a comparator. The Wilcoxon rank sum test was used for intubation times, optimal view times, percentage of glottis opening (POGO) seen, and objective trauma assessment. Student's paired t-test was used for subjective trauma assessment and a Bonferroni correction was used for the primary outcome measures. RESULTS Participants declared a median of 60 (range 20 to 300) previous intubations. Time to achieve optimal view between APA and GSR was not different (20 seconds vs. 19 seconds; p = 0.19), but tracheal intubation was significantly faster with the APA (25 seconds vs. 46 seconds; p < 0.0001). Intubation success was ultimately 97% in both groups. Participants judged subjective trauma to be less for the APA than GSR on a VAS (1.6 cm vs. 3.3 cm; p < 0.001). More than three additional forward advances were required in 43% of GSR and 0% of APA intubations. CONCLUSIONS Following a brief demonstration to paramedics naïve to video laryngoscopy, the APA demonstrated earlier intubation, fewer additional discrete forward advances of the tube, and less participant-judged subjective trauma when compared to the GSR in this simulation model.
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Affiliation(s)
- Angus G Butchart
- Department of Anaesthesia, Queen Elizabeth Hospital, King's Lynn, UK
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