scholarly journals Using supraglottic airways by paramedics for airway management in analogue microgravity increases speed and success of ventilation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jochen Hinkelbein ◽  
Anton Ahlbäck ◽  
Christine Antwerber ◽  
Lisa Dauth ◽  
James DuCanto ◽  
...  
Keyword(s):  
Airway Management ◽  
Success Rate ◽  
Simulated Microgravity ◽  
Laryngeal Tube ◽  
Space Missions ◽  
Airway Device ◽  
Future Space ◽  
Secondary Endpoints ◽  
Present Trial

AbstractIn the next few years, the number of long-term space missions will significantly increase. Providing safe concepts for emergencies including airway management will be a highly challenging task. The aim of the present trial is to compare different airway management devices in simulated microgravity using a free-floating underwater scenario. Five different devices for airway management [laryngeal mask (LM), laryngeal tube (LT), I-GEL, direct laryngoscopy (DL), and video laryngoscopy (VL)] were compared by n = 20 paramedics holding a diving certificate in a randomized cross-over setting both under free-floating conditions in a submerged setting (pool, microgravity) and on ground (normogravity). The primary endpoint was the successful placement of the airway device. The secondary endpoints were the number of attempts and the time to ventilation. A total of 20 paramedics (3 female, 17 male) participated in this study. Success rate was highest for LM and LT and was 100% both during simulated microgravity and normogravity followed by the I-GEL (90% during microgravity and 95% during normogravity). However, the success rate was less for both DL (60% vs. 95%) and VL (20% vs. 60%). Fastest ventilation was performed with the LT both in normogravity (13.7 ± 5.3 s; n = 20) and microgravity (19.5 ± 6.1 s; n = 20). For the comparison of normogravity and microgravity, time to ventilation was shorter for all devices on the ground (normogravity) as compared underwater (microgravity). In the present study, airway management with supraglottic airways and laryngoscopy was shown to be feasible. Concerning the success rate and time to ventilation, the optimum were supraglottic airways (LT, LM, I-GEL) as their placement was faster and associated with a higher success rate. For future space missions, the use of supraglottic airways for airway management seems to be more promising as compared to tracheal intubation by DL or VL.

scholarly journals Ellenőrző lista hatása a légútbiztosítás korai szövődményeire felnőttekben

2019 ◽  
Vol 160 (26) ◽  
pp. 1025-1035 ◽  
Author(s):  
Zoltán Pál Szűcs ◽  
János Farkas ◽  
Péter Schimert ◽  
Zsolt Baranyai ◽  
Elek Dinya
Keyword(s):  
Airway Management ◽  
Primary Endpoint ◽  
Soft Tissues ◽  
Controlled Study ◽  
Data Collection Sheet ◽  
Before And After ◽  
Secondary Endpoints ◽  
Short And Long Term ◽  
Prospective Controlled Study

Abstract: Introduction: Airway management is an integral part of general anaesthesia, which may lead to severe short- and long-term complications. Aim: We assessed whether the application of a checklist for the steps of airway management reduces the number of complications in our institute. Method: In our observational, prospective, controlled study we made a checklist and a data collection sheet. Each airway management was performed for one month without the checklist and then for one month in the possession of the checklist. We evaluated the outcome of airway maneuvers and the occurrence of related early complications before and after the introduction of the checklist. The primary endpoint was the incidence of unexpected difficult airway. The secondary endpoints were difficult intubation, successful first intubation, aspiration, cardiac arrest, post-induction hypotension and desaturation, soft tissues/teeth injuries. Our results were also corrected for factors that affect the risk of complications (urgency of interventions, medical experience). Results: We did not find any difference in the frequency of acute complications before the introduction of the checklist (n = 439) and during the subsequent period (n = 423). At the primary endpoint (7.29% and 6.14%), there was no substantive difference (1.15%, 95% CI: –2.26%–4.56%, p = 0.5). No differences were found regarding the secondary and other endpoints. Following the correction of risk factors, there was no impact of the checklist on the incidence of complications. Conclusion: The introduction of the checklist in itself did not result in a significant change in the risk of short-term complications of airway management in our institution. Orv Hetil. 2019; 160(26): 1025–1035.

scholarly journals A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maja Pålsdatter Lønvik ◽  
Odd Eirik Elden ◽  
Mats Joakimsen Lunde ◽  
Trond Nordseth ◽  
Karin Elvenes Bakkelund ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Success Rate ◽  
Clinical Performance ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Ambulance Personnel ◽  
Increased Risk ◽  
Supraglottic Airway Devices ◽  
Hospital Cardiac Arrest

Abstract Background Airway management in patients with out of hospital cardiac arrest (OHCA) is important and several methods are used. The establishment of a supraglottic airway device (SAD) is a common technique used during OHCA. Two types of SAD are routinely used in Norway; the Kings LTS-D™ and the I-gel®. The aim of this study was to compare the clinical performance of these two devices in terms of difficulty, number of attempts before successful insertion and overall success rate of insertion. Methods All adult patients with OHCA, in whom ambulance personnel used a SAD over a one-year period in the ambulance services of Central Norway, were included. After the event, a questionnaire was completed and the personnel responsible for the airway management were interviewed. Primary outcomes were number of attempts until successful insertion, by either same or different ambulance personnel, and the difficulty of insertion graded by easy, medium or hard. Secondary outcomes were reported complications with inserting the SAD’s. Results Two hundred and fifty patients were included, of whom 191 received I-gel and 59 received LTS-D. Overall success rate was significantly higher in I-gel (86%) compared to LTS-D (75%, p = 0.043). The rates of successful placements were higher when using I-gel compared to LTS-D, and there was a significant increased risk that the insertion of the LTS-D was unsuccessful compared to the I-gel (risk ratio 1.8, p = 0.04). I-gel was assessed to be easy to insert in 80% of the patients, as opposed to LTS-D which was easy to insert in 51% of the patients. Conclusions Overall success rate was significantly higher and the difficulty in insertion was significantly lower in the I-gel group compared to the LTS-D in patients with OHCA.

Airway management during out-of-hospital cardiac arrest; a prospective observational study comparing I-gel® and LTS-D ™

2020 ◽  
Author(s):  
Maja Lønvik ◽  
Odd Eirik Elden ◽  
Mats Lunde ◽  
Trond Nordseth ◽  
Karin Bakkelund ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Success Rate ◽  
Clinical Performance ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Chi Square ◽  
Ambulance Personnel ◽  
Chi Square Test ◽  
Hospital Cardiac Arrest

Abstract Background: Airway management in patients with out of hospital cardiac arrest (OHCA) is important and several methods are used. The establishment of a supraglottic airway device (SAD) is a common technique used during OHCA. Two types of SAD are routinely used in Norway; the Kings LTS-D™ and the I-gel®. The aim of this study was to compare the clinical performance of these two devices in terms of difficulty and number of attempts before successful insertion.Methods: All adult patients with OHCA, in whom ambulance personnel used a SAD over a one-year period in the ambulance services of Central Norway, were included. After the event, a questionnaire was completed and the personnel responsible for the airway management were interviewed. Primary outcomes were number of attempts until successful placement of SAD and graded difficulty of insertion. Secondary outcomes were specified challenges with the SAD at insertion. Intergroup differences were compared using Chi-square test for multiple groups.Results: Two hundred and fifty patients were included, of whom 191 received I-gel and 59 received LTS-D. Overall success rate was significantly higher in I-gel (86 %) compared to LTS-D (75%, p = 0,043). The difficulties of insertion were significantly lower among patients receiving I-gel (easy 80 %, medium 13 % and difficult 7 %) compared to LTS-D (easy 51 %, medium 22 % and difficult 27 %, p < 0,001). Conclusions: Overall success rate was significantly higher and the difficulty in insertion was significantly lower in the I-gel group compared to the LTS-D in patients with OHCA.

Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽  
2002 ◽  
Vol 31 (1) ◽  
pp. 36-42 ◽  
Author(s):  
. Bucek ◽  
Hudak ◽  
Schnürer ◽  
Ahmadi ◽  
Wolfram ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Stage ◽  
Ankle Brachial Index ◽  
Clinical Situation ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Term Outcome ◽  
Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

Towards the Affective Cognition Approach to Human Performance in Space

2020 ◽  
Vol 91 (6) ◽  
pp. 532-534
Author(s):  
Nicola Mammarella
Keyword(s):  
Cognitive Performance ◽  
Cognitive Processing ◽  
Human Performance ◽  
Space Missions ◽  
Cognition And Emotion ◽  
Dynamic Relation ◽  
Interesting Pattern

INTRODUCTION: In recent decades, there has been investigation into the effects of microgravity and microgravity-like environments on cognition and emotion separately. Here we highlight the need of focusing on emotion-cognition interactions as a framework for explaining cognitive performance in space. In particular, by referring to the affective cognition hypothesis, the significant interplay between emotional variables and cognitive processing in space is briefly analyzed. Altogether, this approach shows an interesting pattern of data pointing to a dynamic relation that may be sensitive to microgravity. The importance of examining interactions between emotion and cognition for space performance remains fundamental (e.g., stress-related disorders) and deserves further attention. This approach is ultimately interesting considering the potential effects that microgravity may play on human performance during long-term space missions and on return to Earth.Mammarella N. Towards the affective cognition approach to human performance in space. Aerosp Med Hum Perform. 2020; 91(6):532–534.

CHANGES IN BLOOD PROTEOME OF COSMONAUTS WITH MICRO- AND MACROVASCULAR INJURIES DUE TO G-LOADS AT THE FINAL STAGE OF LONG-DURATION SPACE MISSIONS

2020 ◽  
Vol 54 (5) ◽  
pp. 5-14
Author(s):  
L.Kh. Pastushkova ◽  
◽  
K.S. Kireev ◽  
I.M. Larina ◽  
◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Soft Tissues ◽  
Blood Rheology ◽  
Landing Site ◽  
Space Missions ◽  
Vascular Injuries ◽  
New Approach ◽  
Long Duration ◽  
Integrated Response

The integrated response of the human proteome to re-entry g-loads following long-term space missions was studied in 13 male cosmonauts at the age of 44 ± 6 years. Examination at the landing site discovered local petechial hemorrhages into soft tissues of the back and lower legs. The paper presents a new approach to evaluation of petechia and soft tissue hemorrhages in cosmonauts on return to Earth. Proteomic analysis was performed with the use of LC-MS. Bioinformation analysis was made using Perseus, PubMed, Uniprot and ANDSystem software. Nine out of 19 significantly different (p < 0.05) proteins were related to vascular injuries directly. We described proteins with a primarily protecting effect against endothelial cells apoptosis and augmentation of vascular permeability, proteins that are responsible for blood rheology and proteins antagonistic to the main triggers of ischeamia-reperfusion injuries of the lungs, liver and other parenchymal organs.

scholarly journals Nurse-based secondary preventive follow-up by telephone reduced recurrence of cardiovascular events: a randomised controlled trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anna-Lotta Irewall ◽  
Anders Ulvenstam ◽  
Anna Graipe ◽  
Joachim Ögren ◽  
Thomas Mooe
Keyword(s):  
Randomised Controlled Trial ◽  
Primary Endpoint ◽  
Cardiovascular Events ◽  
Controlled Trial ◽  
Control Group ◽  
Coronary Syndrome ◽  
Secondary Endpoints ◽  
Randomised Controlled

AbstractEnhanced follow-up is needed to improve the results of secondary preventive care in patients with established cardiovascular disease. We examined the effect of long-term, nurse-based, secondary preventive follow-up by telephone on the recurrence of cardiovascular events. Open, randomised, controlled trial with two parallel groups. Between 1 January 2010 and 31 December 2014, consecutive patients (n = 1890) admitted to hospital due to stroke, transient ischaemic attack (TIA), or acute coronary syndrome (ACS) were included. Participants were randomised (1:1) to nurse-based telephone follow-up (intervention, n = 944) or usual care (control, n = 946) and followed until 31 December 2017. The primary endpoint was a composite of stroke, myocardial infarction, cardiac revascularisation, and cardiovascular death. The individual components of the primary endpoint, TIA, and all-cause mortality were analysed as secondary endpoints. The assessment of outcome events was blinded to study group assignment. After a mean follow-up of 4.5 years, 22.7% (n = 214) of patients in the intervention group and 27.1% (n = 256) in the control group reached the primary composite endpoint (HR 0.81, 95% CI 0.68–0.97; ARR 4.4%, 95% CI 0.5–8.3). Secondary endpoints did not differ significantly between groups. Nurse-based secondary preventive follow-up by telephone reduced the recurrence of cardiovascular events during long-term follow-up.

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