Uso del tubo laríngeo por paramédicos noruegos fuera del hospital durante paro cardiaco
Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway.
Sunde GA, Brattebø G, Odegården T, Kjernlie DF, Rødne E, Heltne JK.
Scand J Trauma Resusc Emerg Med. 2012 Dec 18;20(1):84.
Abstract
ABSTRACT: BACKGROUND: Although there are numerous supraglottic airway alternatives to endotracheal intubation, it remains unclear which airway technique is optimal for use in prehospital cardiac arrests. We evaluated the use of the laryngeal tube (LT) as an airway management tool among adult out-of-hospital cardiac arrest (OHCA) patients treated by our ambulance services in the Haukeland and Innlandet hospital districts. METHODS: Post-resuscitation forms and data concerning airway management in 347 adult OHCA victims were retrospectively assessed with regard to LT insertion success rates, ease and speed of insertion and insertion-related problems. RESULTS: A total of 402 insertions were performed on 347 OHCA patients. Overall, LT insertion was successful in 85.3% of the patients, with a 74.4% first-attempt success rate. In the minority of patients (n = 46, 13.3%), the LT insertion time exceeded 30 seconds. Insertion-related problems were recorded in 52.7% of the patients. Lack of respiratory sounds on auscultation (n = 100, 28.8%), problematic initial tube positioning (n = 85, 24.5%), air leakage (n = 61, 17.6%), vomitus/aspiration (n = 44, 12.7%), and tube dislocation (n = 17, 4.9%) were the most common problems reported. Insertion difficulty was graded and documented for 95.4% of the patients, with the majority of insertions assessed as being "Easy" (62.5%) or "Intermediate" (24.8%). Only 8.1% of the insertions were considered to be "Difficult". CONCLUSIONS: We found a high number of insertion related problems, indicating that supraglottic airway devices offering promising results in manikin studies may be less reliable in real-life resuscitations. Still, we consider the laryngeal tube to be an important alternative for airway management in prehospital cardiac arrest victims.
http://www.sjtrem.com/content/pdf/1757-7241-20-84.pdf
Laicos puede colocar con éxitos los dispositivos supraglóticos con tres minutos de entrenamiento. Comparación en cuatros maniquís diferentes
Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin.
Schälte G, Stoppe C, Aktas M, Coburn M, Rex S, Schwarz M, Rossaint R, Zoremba N.
Department of Anesthesiology, University Hospital Aachen, Aachen, Germany. gschaelte@ukaachen.de
Scand J Trauma Resusc Emerg Med. 2011 Oct 24;19:60. doi: 10.1186/1757-7241-19-60.
Abstract
INTRODUCTION: Supraglottic airway devices have frequently been shown to facilitate airway management and are implemented in the ILCOR resuscitation algorithm. Limited data exists concerning laypersons without any medical or paramedical background. We hypothesized that even laymen would be able to operate supraglottic airway devices after a brief training session. METHODS: Four different supraglottic airway devices: Laryngeal Mask Classic (LMA), Laryngeal Tube (LT), Intubating Laryngeal Mask (FT) and CobraPLA (Cobra) were tested in 141 volunteers recruited in a technical university cafeteria and in a shopping mall. All volunteers received a brief standardized training session. Primary endpoint was the time required to definitive insertion. In a short questionnaire applicants were asked to assess the devices and to answer some general questions about BLS. RESULTS: The longest time to insertion was observed for Cobra (31.9 ± 27.9 s, range: 9-120, p < 0.0001; all means ± standard deviation). There was no significant difference between the insertion times of the other three devices. Fewest insertion attempts were needed for the FT (1.07 ± 0.26), followed by the LMA (1.23 ± 0.52, p > 0.05), the LT (1.36 ± 0.61, p < 0.05) and the Cobra (1.45 ± 0.7, p < 0.0001). Ventilation was achieved on the first attempt significantly more often with the FT (p < 0.001) compared to the other devices. Nearly 90% of the participants were in favor of implementing supraglottic airway devices in first aid algorithms and classes. CONCLUSION: Laypersons are able to operate supraglottic airway devices in manikin with minimal instruction. Ventilation was achieved with all devices tested after a reasonable time and with a high success rate of > 95%. The use of supraglottic airway devices in first aid and BLS algorithms should be considered.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213203/pdf/1757-7241-19-60.pdf
Experiencia inicial con el dispositivo supraglótico I-gel por residentes en pacientes pediátricos
Initial experience of the i-gel supraglottic airway by the residents in pediatric patients.
Abukawa Y, Hiroki K, Ozaki M.
Department of Anesthesia and Critical Care, Tokyo Women's Medical University, Tokyo, Japan. yukako1@rg8.so-net.ne.jp
J Anesth. 2012 Jun;26(3):357-61. doi: 10.1007/s00540-011-1322-1. Epub 2012 Feb 7.Abstract
PURPOSE: Insertion of a laryngeal mask airway (LMA) is occasionally difficult in children because of their anatomical features and variations. A new single-use supraglottic airway device, the i-gel airway, was recently introduced. The objective of this study was to show the initial experience of the i-gel airway device by the residents for pediatric patients. METHODS: With approval from the local ethics committee and parental informed consent, 70 children undergoing minor surgery in the supine position, ASA score I-II, were investigated. Exclusion included patients having thoracic, neurosurgical, spine, and otolaryngological procedures. Patients were divided into three groups: group 1 was airway size 1.5 for patients weighing 5-12 kg, group 2 was size 2 for 10-25 kg, and group 3 was size 2.5 for those weighing 25-35 kg. The following seven characteristics were evaluated: (1) ease of the i-gel and gastric tube insertion; (2) leak pressure; (3) tidal volume/body weight at leak pressure point; (4) fiberscope score; (5) insertion time; (6) hypoxia rate (laryngospasm); and (7) coughing and trace of bleeding. RESULTS: The overall insertion success rate and the success rate at first attempt were 99% and 94%, respectively. Gastric tube insertions were easy in all patients. The overall leak pressure was 23 ± 5 cmH(2)O. The tidal volume per body weight was 24 ± 10 ml/kg. A good view of the fiberscope was achieved in 79%. In group 1 (size 1.5), one failed insertion, two dislocations, and one dysphonia were observed. Hypoxia rate was 1%. There was no case with coughing and trace of bleeding. CONCLUSION: These results show that the i-gel airway is a safe and effective device for use by residents who do not have experience with insertion of a pediatric LMA. However, using size 1.5, special caution should be taken to protect the infant airway, similar to what has been previously reported for other airway devices.
http://link.springer.com/content/pdf/10.1007%2Fs00540-011-1322-1
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway.
Sunde GA, Brattebø G, Odegården T, Kjernlie DF, Rødne E, Heltne JK.
Scand J Trauma Resusc Emerg Med. 2012 Dec 18;20(1):84.
Abstract
ABSTRACT: BACKGROUND: Although there are numerous supraglottic airway alternatives to endotracheal intubation, it remains unclear which airway technique is optimal for use in prehospital cardiac arrests. We evaluated the use of the laryngeal tube (LT) as an airway management tool among adult out-of-hospital cardiac arrest (OHCA) patients treated by our ambulance services in the Haukeland and Innlandet hospital districts. METHODS: Post-resuscitation forms and data concerning airway management in 347 adult OHCA victims were retrospectively assessed with regard to LT insertion success rates, ease and speed of insertion and insertion-related problems. RESULTS: A total of 402 insertions were performed on 347 OHCA patients. Overall, LT insertion was successful in 85.3% of the patients, with a 74.4% first-attempt success rate. In the minority of patients (n = 46, 13.3%), the LT insertion time exceeded 30 seconds. Insertion-related problems were recorded in 52.7% of the patients. Lack of respiratory sounds on auscultation (n = 100, 28.8%), problematic initial tube positioning (n = 85, 24.5%), air leakage (n = 61, 17.6%), vomitus/aspiration (n = 44, 12.7%), and tube dislocation (n = 17, 4.9%) were the most common problems reported. Insertion difficulty was graded and documented for 95.4% of the patients, with the majority of insertions assessed as being "Easy" (62.5%) or "Intermediate" (24.8%). Only 8.1% of the insertions were considered to be "Difficult". CONCLUSIONS: We found a high number of insertion related problems, indicating that supraglottic airway devices offering promising results in manikin studies may be less reliable in real-life resuscitations. Still, we consider the laryngeal tube to be an important alternative for airway management in prehospital cardiac arrest victims.
http://www.sjtrem.com/content/pdf/1757-7241-20-84.pdf
Laicos puede colocar con éxitos los dispositivos supraglóticos con tres minutos de entrenamiento. Comparación en cuatros maniquís diferentes
Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin.
Schälte G, Stoppe C, Aktas M, Coburn M, Rex S, Schwarz M, Rossaint R, Zoremba N.
Department of Anesthesiology, University Hospital Aachen, Aachen, Germany. gschaelte@ukaachen.de
Scand J Trauma Resusc Emerg Med. 2011 Oct 24;19:60. doi: 10.1186/1757-7241-19-60.
Abstract
INTRODUCTION: Supraglottic airway devices have frequently been shown to facilitate airway management and are implemented in the ILCOR resuscitation algorithm. Limited data exists concerning laypersons without any medical or paramedical background. We hypothesized that even laymen would be able to operate supraglottic airway devices after a brief training session. METHODS: Four different supraglottic airway devices: Laryngeal Mask Classic (LMA), Laryngeal Tube (LT), Intubating Laryngeal Mask (FT) and CobraPLA (Cobra) were tested in 141 volunteers recruited in a technical university cafeteria and in a shopping mall. All volunteers received a brief standardized training session. Primary endpoint was the time required to definitive insertion. In a short questionnaire applicants were asked to assess the devices and to answer some general questions about BLS. RESULTS: The longest time to insertion was observed for Cobra (31.9 ± 27.9 s, range: 9-120, p < 0.0001; all means ± standard deviation). There was no significant difference between the insertion times of the other three devices. Fewest insertion attempts were needed for the FT (1.07 ± 0.26), followed by the LMA (1.23 ± 0.52, p > 0.05), the LT (1.36 ± 0.61, p < 0.05) and the Cobra (1.45 ± 0.7, p < 0.0001). Ventilation was achieved on the first attempt significantly more often with the FT (p < 0.001) compared to the other devices. Nearly 90% of the participants were in favor of implementing supraglottic airway devices in first aid algorithms and classes. CONCLUSION: Laypersons are able to operate supraglottic airway devices in manikin with minimal instruction. Ventilation was achieved with all devices tested after a reasonable time and with a high success rate of > 95%. The use of supraglottic airway devices in first aid and BLS algorithms should be considered.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213203/pdf/1757-7241-19-60.pdf
Experiencia inicial con el dispositivo supraglótico I-gel por residentes en pacientes pediátricos
Initial experience of the i-gel supraglottic airway by the residents in pediatric patients.
Abukawa Y, Hiroki K, Ozaki M.
Department of Anesthesia and Critical Care, Tokyo Women's Medical University, Tokyo, Japan. yukako1@rg8.so-net.ne.jp
J Anesth. 2012 Jun;26(3):357-61. doi: 10.1007/s00540-011-1322-1. Epub 2012 Feb 7.Abstract
PURPOSE: Insertion of a laryngeal mask airway (LMA) is occasionally difficult in children because of their anatomical features and variations. A new single-use supraglottic airway device, the i-gel airway, was recently introduced. The objective of this study was to show the initial experience of the i-gel airway device by the residents for pediatric patients. METHODS: With approval from the local ethics committee and parental informed consent, 70 children undergoing minor surgery in the supine position, ASA score I-II, were investigated. Exclusion included patients having thoracic, neurosurgical, spine, and otolaryngological procedures. Patients were divided into three groups: group 1 was airway size 1.5 for patients weighing 5-12 kg, group 2 was size 2 for 10-25 kg, and group 3 was size 2.5 for those weighing 25-35 kg. The following seven characteristics were evaluated: (1) ease of the i-gel and gastric tube insertion; (2) leak pressure; (3) tidal volume/body weight at leak pressure point; (4) fiberscope score; (5) insertion time; (6) hypoxia rate (laryngospasm); and (7) coughing and trace of bleeding. RESULTS: The overall insertion success rate and the success rate at first attempt were 99% and 94%, respectively. Gastric tube insertions were easy in all patients. The overall leak pressure was 23 ± 5 cmH(2)O. The tidal volume per body weight was 24 ± 10 ml/kg. A good view of the fiberscope was achieved in 79%. In group 1 (size 1.5), one failed insertion, two dislocations, and one dysphonia were observed. Hypoxia rate was 1%. There was no case with coughing and trace of bleeding. CONCLUSION: These results show that the i-gel airway is a safe and effective device for use by residents who do not have experience with insertion of a pediatric LMA. However, using size 1.5, special caution should be taken to protect the infant airway, similar to what has been previously reported for other airway devices.
http://link.springer.com/content/pdf/10.1007%2Fs00540-011-1322-1
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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