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Xu X, Ma H, Zhang Y, Liu W, Jung B, Li X, Shen L. Efficacy of bougie first approach for endotracheal intubation with video laryngoscopy during continuous chest compression: a randomized crossover manikin trial. BMC Anesthesiol 2024; 24:181. [PMID: 38773386 PMCID: PMC11106944 DOI: 10.1186/s12871-024-02560-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Endotracheal intubation is challenging during cardiopulmonary resuscitation, and video laryngoscopy has showed benefits for this procedure. The aim of this study was to compare the effectiveness of various intubation approaches, including the bougie first, preloaded bougie, endotracheal tube (ETT) with stylet, and ETT without stylet, on first-attempt success using video laryngoscopy during chest compression. METHODS This was a randomized crossover trial conducted in a general tertiary teaching hospital. We included anesthesia residents in postgraduate year one to three who passed the screening test. Each resident performed intubation with video laryngoscopy using the four approaches in a randomized sequence on an adult manikin during continuous chest compression. The primary outcome was the first-attempt success defined as starting ventilation within a one minute. RESULTS A total of 260 endotracheal intubations conducted by 65 residents were randomized and analyzed with 65 procedures in each group. First-attempt success occurred in 64 (98.5%), 57 (87.7%), 56 (86.2%), and 46 (70.8%) intubations in the bougie-first, preloaded bougie, ETT with stylet, and ETT without stylet approaches, respectively. The bougie-first approach had a significantly higher possibility of first-attempt success than the preloaded bougie approach [risk ratio (RR) 8.00, 95% confidence interval (CI) 1.03 to 62.16, P = 0.047], the ETT with stylet approach (RR 9.00, 95% CI 1.17 to 69.02, P = 0.035), and the ETT without stylet approach (RR 19.00, 95% CI 2.62 to 137.79, P = 0.004) in the generalized estimating equation logistic model accounting for clustering of intubations operated by the same resident. In addition, the bougie first approach did not result in prolonged intubation or increased self-reported difficulty among the study participants. CONCLUSIONS The bougie first approach with video laryngoscopy had the highest possibility of first-attempt success during chest compression. These results helped inform the intubation approach during CPR. However, further studies in an actual clinical environment are warranted to validate these findings. TRIAL REGISTRATION Clinicaltrials.gov; identifier: NCT05689125; date: January 18, 2023.
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Affiliation(s)
- Xiaohan Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China
| | - Haobo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Yuelun Zhang
- Center for Prevention and Early Intervention, National Infrastructures for Translational Medicine, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Wei Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China
| | - Boris Jung
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Intensive Care Unit, Lapeyronie Teaching Hospital, Montpellier University, Montpellier, France
- Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Xu Li
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China.
| | - Le Shen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China.
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Budde AM, Tung A. Airway management during resuscitation. Int Anesthesiol Clin 2023; 61:9-14. [PMID: 37678199 DOI: 10.1097/aia.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Anna M Budde
- Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Avery Tung
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
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Videolaryngoscopy versus direct laryngoscopy for endotracheal intubation of cardiac arrest patients in hospital: A systematic literature review. Resusc Plus 2022; 11:100297. [PMID: 36111271 PMCID: PMC9468586 DOI: 10.1016/j.resplu.2022.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
Aims Airway management during cardiopulmonary resuscitation may involve endotracheal intubation complicated by associated difficulties. Videolaryngoscopy may help to ease these difficulties and increase success rates by removing the need to achieve a direct line of sight required by standard direct laryngoscopy. This literature review aims to establish if there is an overall benefit in using videolaryngoscopy over direct laryngoscopy when intubating patients during cardiac arrest in the non-theatre hospital environment. Methods The review was registered on PROSPERO (record ID 329987). A systematic search was conducted of EMBASE, MEDLINE, CINAHL and Web of Science for literature comparing the use of videolaryngoscopy to direct laryngoscopy during intubation of cardiac arrest patients in hospital up until 4th May 2022. The Cochrane Central Register of Controlled Trials (CENTRAL) database was accessed, and reference lists of relevant systematic reviews were analysed for further papers. Forward and backward citation tracking was carried out of the shortlisted papers to hand-search for any further relevant studies. Papers were included in the review if they used adult patients, the patients were intubated during cardiac arrest in hospital and if the papers were in English language or had an accessible translation. Papers were excluded if patients were intubated not during cardiac arrest, the studies were based outside of a hospital setting or in the operating theatre, the patients were paediatric or if the study used a simulation or manikin. The Critical Appraisal Skills Programme checklists were used to assess risk of bias. Odds ratios, confidence intervals and probability values were used to synthesise results. Results Six studies were identified that collectively analysed 4525 patients who were intubated during cardiac arrest in the non-theatre hospital environment; five studies were observational and one a randomised controlled trial. Most of the studies being observational in nature led to a significant bias in their methodology which is a limitation to this review. The studies all measured first pass success rate as the primary outcome. First pass success rate only improved with videolaryngoscopy compared to direct laryngoscopy when the intubator was a less experienced clinician. Videolaryngoscopy also reduced some endotracheal intubation related complications and improved glottic visualisation when compared to direct laryngoscopy. Conclusion The limited data suggests that use of videolaryngoscopy improved first pass success rates compared to direct laryngoscopy when the clinician was less experienced.
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Pacheco GS, Patanwala AE, Leetch AN, Mendelson JS, Hurst NB, Sakles JC. Intubation During Pediatric Cardiac Arrest in the Emergency Department Is Associated With Reduced First-Pass Success. Pediatr Emerg Care 2022; 38:e1271-e1276. [PMID: 35482505 DOI: 10.1097/pec.0000000000002592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Airway compromise and respiratory failure are leading causes of pediatric cardiac arrest making advanced airway management central to pediatric resuscitation. Previous literature has demonstrated that achieving first-pass success (FPS) is associated with fewer adverse events. In cardiac arrest for adult patients, increasing number of intubation attempts is associated with lower likelihood of return of spontaneous circulation (ROSC) and favorable neurologic outcome. There is limited evidence regarding advanced airway management for pediatric out-of-hospital cardiac arrest (OHCA) in the emergency department (ED). The purpose of this study was to compare FPS in pediatric OHCA and non-cardiac arrest patients in the ED. METHODS This is an analysis of pediatric intubations prospectively recorded into a continuous quality improvement database in an academic pediatric ED over a 12-year period. Between July 1, 2007, and June 30, 2019, physicians recorded all intubations performed in the pediatric ED. The database included patient demographics and detailed information about each intubation such as age of the patient, reason for intubation, number of intubation attempts, and outcome of each attempt. All patients younger than 18 years who underwent intubation in the ED were eligible for inclusion in the study. The primary outcome was FPS for pediatric patients in cardiac arrest compared with those not in cardiac arrest. A logistic regressions analysis was performed to identify characteristics associated with FPS in OHCA patients. RESULTS Six hundred eight pediatric patients were intubated during the study period. One hundred three pediatric patients had OHCA compared with 459 non-cardiac arrest patients who underwent rapid sequence intubation. In patients with OHCA, 47.6% had FPS (95% confidence interval [CI], 38.2%-57.1%), 33% required 2 attempts (95% CI, 24.7%-42.6%), and 19.4% required 3 or more attempts (95% CI, 12.9%-28.2%). In patients without OHCA, 75.4% had FPS (95% CI, 75.4%-79.1%), 15% required 2 attempts (95% CI, 12.0%-18.6%), and 9.6% required 3 or more attempts (95% CI, 7.2%-12.6%). Cardiac arrest was associated with a reduction in FPS adjusted odds ratio 0.44 (95% CI, 0.26-0.77). CONCLUSIONS In this study, we found that pediatric OHCA is associated with reduced FPS in the ED. Although additional studies are needed, rescuers should prioritize restoring effective oxygenation and ventilation and optimizing intubation conditions before an advanced airway attempt.
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Affiliation(s)
| | - Asad E Patanwala
- University of Sydney School of Pharmacy Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Dai Y, Walline JH, Yu H, Zhu H, Xu J, Yu X. Tracheal Intubation in Emergency Departments in China: A National Cross-Sectional Survey. Front Med (Lausanne) 2022; 9:813833. [PMID: 35280889 PMCID: PMC8914034 DOI: 10.3389/fmed.2022.813833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Tracheal intubation is a necessary but risky procedure performed in emergency departments (EDs) around the world. Relatively high morbidity has been encountered in Chinese EDs, which has raised concerns about peri-intubation ED management. This study aimed to investigate intubation procedures and identify any areas for improvement in Chinese EDs. Methods This was a questionnaire-based survey lasting 1 month (March 2021) in 41 tertiary-care hospital EDs in mainland China. The primary outcome was complications associated with intubation. Secondary outcomes were the first-pass success rate and blood pressure variations during intubation. Univariate and binary logistic regression analyses were used to find possible risk factors for first-pass intubation failure. Results In total, 1,020 replies were analyzed out of 1,080 surveys submitted (94.4% response rate). Most patients were elderly men with severe medical conditions like cardiac arrest (24.8%). In total, 97.2% of patients were given preoxygenation, and 48.1% received some form of pretreatment. Induction drugs (e.g., etomidate and ketamine) were less often used: 39.9% of intubations used sedatives, 5.5% used analgesics, and only 5.3% used muscle relaxants. The overall first-pass intubation success rate was 85.7% and was accompanied by a 19.8% adverse event rate. A marked decrease in blood pressure after intubation was also identified. Conclusion This survey found an 85.7% tracheal intubation first-pass success rate (which is relatively high compared to other countries) and a 19.8% adverse event rate (which is also relatively high). Given the very low rate of using induction medications (5.3% used muscle relaxants), future education should focus on induction drugs and traditional intubation techniques.
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Affiliation(s)
- Yili Dai
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Joseph Harold Walline
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Heng Yu
- Department of Emergency, Shapingba District People's Hospital, Chongqing, China
| | - Huadong Zhu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jun Xu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Jun Xu
| | - Xuezhong Yu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- Xuezhong Yu
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Nicol T, Gil-Jardiné C, Jabre P, Adnet F, Ecollan P, Guihard B, Ferdynus C, Combes X. Incidence, Complications, and Factors Associated with Out-of-Hospital First Attempt Intubation Failure in Adult Patients: A Secondary Analysis of the CURASMUR Trial Data. PREHOSP EMERG CARE 2021; 26:280-285. [PMID: 33595420 DOI: 10.1080/10903127.2021.1891357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: The objectives of this study were to evaluate first attempt intubation failure rate, its associated factors, and its related complications in out-of-hospital emergency setting, when emergency physicians perform standardized airway management using rapid sequence intubation in adult patients. Material and methods: The present study was a substudy of the Succinylcholine versus Rocuronium for out-of-hospital Emergency Intubation (CURASMUR) Trial, which compared Succinylcholine and Rocuronium used for Rapid sequence intubation. First attempt Intubation failure rate and early intubation related complications were recorded. We used multivariable logistic regression analysis to determine first intubation failure associated factors. Results: A total of 1230 patients were included with mean age of 55.9 +/- 19 years. First attempt intubation failure was recorded in 285 (23.2%) patients. The occurrence of a first attempt intubation failure was independently associated with history of ear, nose, and throat neoplasia (OR 2.20, CI 95% 1.06-4.60). Early intubation related complications were more frequent in case of first attempt intubation failure: 80 of 285 (28.4%) in patients with first attempt intubation failure and 185 of 945 (19.6%) in patients with successful first attempt intubation [OR 1.44; CI 95%, 1.11-1.87]. Conclusion: Based on a large multicenter study on out-of-hospital tracheal intubation of adult patients, we found that first attempt intubation failure rate was high and that history of ear, nose, and throat (ENT) neoplasia was an independent associated factor. Failure in first intubation attempt was associated with significantly more intubation related complications.
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Jiang J, Kang N, Li B, Wu AS, Xue FS. Comparison of adverse events between video and direct laryngoscopes for tracheal intubations in emergency department and ICU patients-a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2020; 28:10. [PMID: 32033568 PMCID: PMC7006069 DOI: 10.1186/s13049-020-0702-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/13/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This systematic review and meta-analysis was designed to determine whether video laryngoscope (VL) compared with direct laryngoscope (DL) could reduce the occurrence of adverse events associated with tracheal intubation in the emergency and ICU patients. METHODS The current issue of Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Web of Science (from database inception to October 30, 2018) were searched. The RCTs, quasi-RCTs, observational studies comparing VL and DL for tracheal intubation in emergency or ICU patients and reporting the rates of adverse events were included. The primary outcome was the rate of esophageal intubation (EI). Review Manager 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible RCT. The ACROBAT-NRSi Cochrane Risk of Bias Tool was applied to assess the risk of bias for each eligible observational study. RESULTS Twenty-three studies (13,117 patients) were included in the review for data extraction. Pooled analysis showed a lower rate of EI by using VL (relative risk [RR], 0.24; P < 0.01; high-quality evidence for RCTs and very low-quality evidence for observational studies). Subgroup analyses based on the type of studies, whether a cardiopulmonary resuscitation study, or operators' expertise showed a similar lower rate of EI by using VL compared with DL in all subgroups (P < 0.01) except for experienced operators (RR, 0.44; P = 0.09). There were no significant differences between devices for other adverse events (P > 0.05), except for a lower incidence of hypoxemia when intubation was performed with VL by inexperienced operators (P = 0.03). CONCLUSIONS Based on the results of this analysis, we conclude that compared with DL, VL can reduce the risk of EI during tracheal intubation in the emergency and ICU patients, but does not provide significant benefits on other adverse events associated with tracheal intubation.
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Affiliation(s)
- Jia Jiang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Na Kang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - An-Shi Wu
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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Hung KC, Yu TS, Sun CK, Chang YJ, Chen IW, Lin CM. Characteristics and outcomes of patients requiring airway rescue by the difficult airway response team in the emergency department and wards: A retrospective study. Tzu Chi Med J 2020; 32:53-57. [PMID: 32110521 PMCID: PMC7015017 DOI: 10.4103/tcmj.tcmj_184_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/10/2018] [Accepted: 10/02/2018] [Indexed: 11/05/2022] Open
Abstract
Objective: In this retrospective cohort study, we aimed to determine the characteristics and outcomes of patients in the emergency department (ED) and wards who required emergency tracheal intubation by the difficult airway response team (DART). Materials and Methods: All patients between 18 and 80 years old receiving emergency tracheal intubation by the DART at a single tertiary referral hospital from January 2014 to December 2016 were reviewed and divided into ward and ED groups. Patient characteristics, comorbidities, indications for intubation, airway maintenance technique, and survival-to-discharge rates were analyzed and compared. Results: Totally, 192 patients (ward, n = 135; ED, n = 57) were eligible for the current study. Compared with the ward group, patients in the ED group were younger (58.9 ± 13 vs. 51.5 ± 15.6 years, P = 0.001), male-predominant (71.1% vs. 87.7%, P = 0.014), and had a higher incidence of trauma (6.7% vs. 22.8%, P = 0.001). The most common indications for tracheal intubation were respiratory distress (52.6%) and cardiac arrest (17.8%) in the ward group, and respiratory distress (31.6%) and airway protection (28.1%) in the ED group. Patients in the ED group received more fiberoptic intubations (42.1% vs. 17.8%, P = 0.039) and had a higher survival-to-discharge rate (87.7% vs. 44.4%, P < 0.001) than those in the ward group. Conclusions: Better recognition of differences in patient characteristics and indications for intubation in different units of the hospital may enable the DART to customize specialized equipment to improve efficiency and implement appropriate strategies for airway rescue to improve patient outcomes.
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Arulkumaran N, Lowe J, Ions R, Mendoza M, Bennett V, Dunser M. Videolaryngoscopy versus direct laryngoscopy for emergency orotracheal intubation outside the operating room: a systematic review and meta-analysis. Br J Anaesth 2018; 120:712-724. [DOI: 10.1016/j.bja.2017.12.041] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/28/2017] [Accepted: 12/13/2017] [Indexed: 01/22/2023] Open
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Hung KC, Lin HJ, Hsieh SW, Sun CK. Impact of intervention time on hospital survival in patients requiring emergent airway management: a preliminary study. J Anesth 2018; 32:153-159. [PMID: 29349508 DOI: 10.1007/s00540-018-2456-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/29/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The time in the day of intervention for physiological deterioration reportedly impacts patient outcomes. This study aimed at determining the impact of the time of ETI on hospital survival in critically ill patients. METHODS Between January 2014 and December 2016, 151 patients who underwent emergency tracheal intubation (ETI) by the airway response team (ART) in the general wards of a tertiary referral center were retrospectively reviewed. Patients were divided into two groups based on the time of ETI (daytime group, 8:00 a.m.-4:00 p.m., n = 57, mean age 63.5 ± 14.1 years; nighttime group, 4:00 p.m.-8:00 a.m., n = 94, mean age 60.4 ± 14.9 years). Data regarding demographic information, comorbidities, trigger events for intubation, survival-to-discharge rates, acute physiology and chronic health evaluation II (APACHE II), ventilator-free days, and airway techniques were collected. RESULTS There was no significant difference in sex, age, body mass index, APACHE II, or comorbidities between the two groups, except that a higher proportion of patients presented with arrhythmias (21.1 vs. 8.5%, p = 0.028) and received fiberoptic intubation (24.6 vs. 11.7%, p = 0.039) in the daytime group than in the nighttime group. The time of the ART arrival after call was also shorter in daytime than that in nighttime (6.1 ± 1.4 vs. 10.5 ± 3.2 min, respectively, p < 0.001). There were no differences in the survival-to-discharge rate (45.6 vs. 43.6%, p = 0.811), ventilator-free days, or trigger events between the two groups. CONCLUSIONS Emergent tracheal intubation in the nighttime may not have negative impact on the survival-to-discharge rate compared with that performed in the daytime.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, No. 901 ChungHwa Road, YungKung District, 71004, Tainan County, Taiwan, ROC.
| | - Hsiu-Jung Lin
- Department of Anesthesiology, E-DA Hospital, Kaohsiung, Taiwan, ROC
| | - Shao-Wei Hsieh
- Department of Anesthesiology, Beigang Hospital, China Medical University, Yunlin, Taiwan, ROC
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan, ROC
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Burns BJ, Watterson JB, Ware S, Regan L, Reid C. Analysis of Out-of-Hospital Pediatric Intubation by an Australian Helicopter Emergency Medical Service. Ann Emerg Med 2017; 70:773-782.e4. [DOI: 10.1016/j.annemergmed.2017.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/10/2017] [Accepted: 03/10/2017] [Indexed: 11/16/2022]
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Darby JM, Halenda G, Chou C, Quinlan JJ, Alarcon LH, Simmons RL. Emergency Surgical Airways Following Activation of a Difficult Airway Management Team in Hospitalized Critically Ill Patients: A Case Series. J Intensive Care Med 2016; 33:517-526. [PMID: 27899469 DOI: 10.1177/0885066616680594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION An emergency surgical airway (ESA) is widely recommended for securing the airway in critically ill patients who cannot be intubated or ventilated. Little is known of the frequency, clinical circumstances, management methods, and outcomes of hospitalized critically ill patients in whom ESA is performed outside the emergency department or operating room environments. METHODS We retrospectively reviewed all adult patients undergoing ESA in our intensive care units (ICUs) and other hospital units from 2008 to 2012 following activation of our difficult airway management team (DAMT). RESULTS Of 207 DAMT activations for native airway events, 22 (10.6%) events culminated in an ESA, with 59% of these events occurring in ICUs with the remainder outside the ICU in the context of rapid response team activations. Of patients undergoing ESA, 77% were male, 63% were obese, and 41% had a history of a difficult airway (DA). Failed planned or unplanned extubations preceded 61% of all ESA events in the ICUs, while bleeding from the upper or lower respiratory tract led to ESA in 44% of events occurring outside the ICU. Emergency surgical airway was the primary method of airway control in 3 (14%) patients, with the remainder of ESAs performed following failed attempts to intubate. Complications occurred in 68% of all ESAs and included bleeding (50%), multiple cannulation attempts (36%), and cardiopulmonary arrest (27%). Overall hospital mortality for patients undergoing ESA was 59%, with 38% of deaths occurring at the time of the airway event. CONCLUSION An ESA is required in approximately 10% of DA events in critically ill patients and is associated with high morbidity and mortality. Efforts directed at early identification of patients with a difficult or challenging airway combined with a multidisciplinary team approach to management may reduce the overall frequency of ESA and associated complications.
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Affiliation(s)
- Joseph M Darby
- 1 Department of Critical Care Medicine, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gregory Halenda
- 2 Department of Anesthesiology, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Courtney Chou
- 3 Department of Otolaryngology, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph J Quinlan
- 2 Department of Anesthesiology, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Louis H Alarcon
- 4 Department of Surgery, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Richard L Simmons
- 4 Department of Surgery, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Rodríguez-Núñez A, Cortiñas-Díaz J. Reply to the correspondence letter by Szarpak L et al. "Can Glidescope® videolaryngoscope be an alternative to direct laryngoscopy for child and infant tracheal intubation during chest compression?". Eur J Pediatr 2015; 174:983. [PMID: 25620027 DOI: 10.1007/s00431-015-2496-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Antonio Rodríguez-Núñez
- Pediatric Emergency and Critical Care Division, Pediatric Area, Hospital Clinico Universitario de Santiago de Compostela, Galicia's Public Health System (SERGAS), Santiago de Compostela, Spain,
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Honarmand A, Safavi M, Badiei S, Daftari-Fard N. Different doses of intravenous Magnesium sulfate on cardiovascular changes following the laryngoscopy and tracheal intubation: A double-blind randomized controlled trial. J Res Pharm Pract 2015; 4:79-84. [PMID: 25984545 PMCID: PMC4418140 DOI: 10.4103/2279-042x.154365] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Laryngoscopy and intratracheal intubation may cause acute hemodynamic instabilities due to catecholamine release. Magnesium sulfate (MgSO4) prevents catecholamine release and results in bradycardia and vasodilatation, so can be used to diminish complications of laryngoscopy and intubation in doses > 50 mg/kg. The aim of this study was to compare the different doses of MgSO4 used to improve cardiovascular instabilities due to laryngoscopy and intratracheal intubation. METHODS In this double-blind randomized controlled trial, 120 patients undergoing elective surgery were divided equally into four groups (n = 30) and received different doses of MgSO4 as case groups (Group I: 30 mg/kg, Group II: 40 mg/kg, Group III: 50 mg/kg) or the equal volume of normal saline as a control group. The patients' hemodynamic status was recorded at baseline, before laryngoscopy and in 1, 3, 5, and 10 minutes after laryngoscopy. Bradycardia, tachycardia, hypertension, hypotension, ST-T changes, arrhythmias, and duration of extubation and laryngoscopy were also recorded. FINDINGS There was no significant difference in heart rate between four groups (Pbaseline = 0.46, Ppreoperation = 0.55, P1 min = 0.86, P3 min = 0.30, P5 min = 0.63, P10 min = 0.74). Systolic, diastolic and mean arterial pressures were statistically significant less at 1, 3, and 5 minutes after intubation in comparison with other times of following-up in the three groups received MgSO4 than the control group. CONCLUSION The use of MgSO4 in doses less than 50 mg/kg can be effective to reduce cardiovascular instability related to laryngoscopy and tracheal intubation.
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Affiliation(s)
- Azim Honarmand
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Safavi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sajad Badiei
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Daftari-Fard
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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