scholarly journals 1355: MEDICATION-FACILITATED ADVANCED AIRWAY MANAGEMENT WITH FIRST-LINE USE OF A SUPRAGLOTTIC DEVICE

2021 ◽  
Vol 50 (1) ◽  
pp. 679-679
Author(s):  
Bethany Johnston ◽  
Alison Leung ◽  
Jason Jones ◽  
Muhammad Abdul Baker Chowdhury ◽  
Charles Hwang ◽  
...  
Keyword(s):  
Airway Management ◽  
First Line ◽  
Advanced Airway

Impact of videolaryngoscopy introduction into prehospital emergency medicine practice: a quality improvement project

2021 ◽  
pp. emermed-2020-209944
Author(s):  
Alistair Steel ◽  
Charlotte Haldane ◽  
Dan Cody
Keyword(s):  
Emergency Medicine ◽  
Tracheal Intubation ◽  
Airway Management ◽  
First Line ◽  
Prehospital Emergency Medicine ◽  
Laryngeal Inlet ◽  
Advanced Airway ◽  
Intubation Success ◽  
First Pass ◽  
Prehospital Emergency

IntroductionAdvanced airway management is necessary in the prehospital environment and difficult airways occur more commonly in this setting. Failed intubation is closely associated with the most devastating complications of airway management. In an attempt to improve the safety and success of tracheal intubation, we implemented videolaryngoscopy (VL) as our first-line device for tracheal intubation within a UK prehospital emergency medicine (PHEM) setting.MethodsAn East of England physician–paramedic PHEM team adopted VL as first line for undertaking all prehospital advanced airway management. The study period was 2016–2020. Statistical process control charts were used to assess whether use of VL altered first-pass intubation success, frequency of intubation-related hypoxia and laryngeal inlet views. A survey was used to collect the team’s views of VL introduction.Results919 patients underwent advanced airway management during the study period. The introduction of VL did not improve first-pass intubation success, view of laryngeal inlet or intubation-associated hypoxia. VL improved situational awareness and opportunities for training but performed poorly in some environments.ConclusionDespite the lack of objective improvement in care, subjective improvements meant that overall PHEM clinicians wanted to retain VL within their practice.

Perception and success rate of using advanced airway management by hospital-based paramedics in the Kingdom of Saudi Arabia

2021 ◽  
Vol 6 (3) ◽  
pp. 24-30
Author(s):  
Amani Alenazi ◽  
Bashayr Alotaibi ◽  
Najla Saleh ◽  
Abdullah Alshibani ◽  
Meshal Alharbi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Airway Management ◽  
Success Rate ◽  
Phase 1 ◽  
Adult Patients ◽  
Supraglottic Airway ◽  
Future Research ◽  
Phase 2 ◽  
Advanced Airway ◽  
Supraglottic Airway Devices

Objective: The study aimed to measure the success rate of pre-hospital tracheal intubation (TI) and supraglottic airway devices (SADs) performed by paramedics for adult patients and to assess the perception of paramedics of advanced airway management.Method: The study consisted of two phases: phase 1 was a retrospective analysis to assess the TI and SADs’ success rates when applied by paramedics for adult patients aged >14 years from 2012 to 2017, and phase 2 was a distributed questionnaire to assess paramedics’ perception of advanced airway management.Result: In phase 1, 24 patients met our inclusion criteria. Sixteen (67%) patients had TI, of whom five had failed TI but then were successfully managed using SADs. The TI success rate was 69% from the first two attempts compared to SADs (100% from first attempt). In phase 2, 63/90 (70%) paramedics responded to the questionnaire, of whom 60 (95%) completed it. Forty-eight (80%) paramedics classified themselves to be moderately or very competent with advanced airway management. However, most of them (80%) performed only 1‐5 TIs or SADs a year.Conclusion: Hospital-based paramedics (i.e. paramedics who are working at hospitals and not in the ambulance service, and who mostly respond to small restricted areas in Saudi Arabia) handled few patients requiring advanced airway management and had a higher competency level with SADs than with TI. The study findings could be impacted by the low sample size. Future research is needed on the success rate and impact on outcomes of using pre-hospital advanced airway management, and on the challenges of mechanical ventilation use during interfacility transfer.

Advanced Airway Management in the Neurologically Injured Patient

2003 ◽  
pp. 679-700
Author(s):  
A. Gabrielli ◽  
L. J. Caruso ◽  
A. J. Layon
Keyword(s):  
Airway Management ◽  
Injured Patient ◽  
Advanced Airway

Advanced Airway Management and Use of Anesthetic Drugs

2001 ◽  
Author(s):  
Charles Smith ◽  
Ron Walls ◽  
David Lockey ◽  
Herbert Kuhnigk
Keyword(s):  
Airway Management ◽  
Anesthetic Drugs ◽  
Advanced Airway

Abstract 168: Association Between Prehospital Advanced Airway Management for Pediatric Out-of-Hospital Cardiac Arrest and Survival

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Masashi Okubo ◽  
Sho Komukai ◽  
Junichi Izawa ◽  
Koichiro Gibo ◽  
Kosuke Kiyohara ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Airway Management ◽  
Patient Outcomes ◽  
Odds Ratio ◽  
Pediatric Patients ◽  
Time Dependent ◽  
Advanced Airway ◽  
Hospital Cardiac Arrest ◽  
Favorable Functional Outcome

Introduction: It is unclear whether prehospital advanced airway management (AAM: endotracheal intubation and supraglottic airway device placement) for pediatric patients with out-of-hospital cardiac arrest (OHCA) improves patient outcomes. Objective: To test the hypothesis that prehospital advanced airway management during pediatric OHCA is associated with patient outcomes. Methods: We conducted a secondary analysis of a nationwide, prospective, population-based OHCA registry in Japan. We included pediatric patients (<18 years) with OHCA in whom emergency medical services (EMS) personnel resuscitated and transported to medical institutions during 2014 and 2015. The primary outcome was one-month survival. Secondary outcome was one-month survival with favorable functional outcome, defined as cerebral performance category score 1 or 2. Patients who received AAM during cardiopulmonary resuscitation by EMS personnel at any given minute were sequentially matched with patients at risk of receiving AAM within the same minutes based on time-dependent propensity score calculated from a competing risk regression model in which we treated prehospital return of spontaneous circulation as a competing risk event. Results: We included 2,548 patients; 1,017 (39.9%) were infants (<1 year), 839 (32.9%) were children (1 year to 12 years), and 692 (27.2%) were adolescents. Of the 2,548, included patients, 336 (13.2%) underwent prehospital AAM during cardiac arrest. In the time-dependent propensity score matched cohort (n = 642), there were no significant differences in one-month survival (AAM: 32/321 [10.0%] vs. no AAM: 27/321 [8.4%]; odds ratio, 1.33 [95% CI, 0.80 to 2.21]) and one-month survival with favorable functional outcome (AAM: 6/321 [1.9%] vs. no AAM: 5/321 [1.6%]; odds ratio, 1.48 [95% CI, 0.41 to 5.40]). Conclusions: Among pediatric patients with OHCA, we found no associations between prehospital AAM and favorable patient outcomes.

Abstract 284: Association of Neurological Outcome and Survival With Interventions by Bystander and Emergency Medical Service for Unwitnessed Out-of-Hospital Cardiac Arrest Patient; Results From the JCS-ReSS Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Chisato Okamoto ◽  
Yoshio Tahara ◽  
Atsushi Hirayama ◽  
Satoshi Yasuda ◽  
Teruo Noguchi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Emergency Medical Service ◽  
Neurological Outcome ◽  
Medical Service ◽  
Favorable Outcome ◽  
Shockable Rhythm ◽  
Advanced Airway ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: Although studies have shown that bystander cardiopulmonary resuscitation (CPR) in witnessed out-of-hospital cardiac arrest (OHCA) is associated with better neurological prognosis, whether bystander and Emergency Medical Service (EMS) interventions are associated with prognosis in unwitnessed OHCA patients is not fully elucidated. We aimed to investigate the prognostic importance of bystander and EMS interventions among unwitnessed OHCA patients in Japan. Methods and Results: This study was a nation-wide population-based observational study of OHCA in Japan from 2011 to 2015 based on data from the All-Japan Utstein Registry. The outcome measures were neurological outcome and survival at 30-day. The neurologically favorable outcome was defined as Glasgow-Pittsburgh cerebral performance category score 1 or 2. First, to investigate the effectiveness of bystander interventions, we included 105,655 unwitnessed cardiogenic OHCA patients (aged 18-80 years). Of these, 1,614 (1.5%) showed neurologically favorable outcome and 3,273 (3.1%) survived at 30-day. Multivariate logistic regression analysis adjusting for age, sex, geographical region, year and EMS response time showed that bystander CPR was associated with neurologically favorable outcome (adjusted odds ratio [aOR] 1.49, 95% CI 1.35-1.65, P<0.001). Additionally, to investigate the effectiveness of EMS interventions for patients with non-shockable rhythm, we examined 43,342 patients who were performed public CPR and had the initial rhythm of pulseless electrical activity (PEA) or asystole. Of these, 101 (0.2%) showed neurologically favorable outcome and 453 (1.0%) were survival at 30-day. Advanced airway management by EMS was negatively associated with neurologically favorable outcome (aOR 0.55, 95% CI 0.37-0.81, P=0.003) and administration of epinephrine by EMS was associated with survival (aOR 2.35, 95% CI 1.89-2.92, P<0.001). Conclusions: Among unwitnessed OHCA patients, bystander CPR was associated with neurologically favorable prognosis. For unwitnessed OHCA patients with non-shockable rhythm, epinephrine administration was associated with survival, but advanced airway management was negatively associated with neurological outcome.

Improvement of Pediatric Advanced Airway Management in General Emergency Departments After a Collaborative Intervention Program

2021 ◽  
Vol 66 (12) ◽  
pp. 1866-1875
Author(s):  
Manahil Mustafa ◽  
Riad Lutfi ◽  
Hani Alsaedi ◽  
Peter Castelluccio ◽  
Kellie J Pearson ◽  
...  
Keyword(s):  
Airway Management ◽  
Emergency Departments ◽  
Intervention Program ◽  
Collaborative Intervention ◽  
Advanced Airway

Preparation for Advanced Airway Management: Pre-oxygenation and Positioning

2019 ◽  
Author(s):  
Arpan Mehta ◽  
Adrian Pichurko
Keyword(s):  
Oxygen Consumption ◽  
Airway Management ◽  
Oxygen Content ◽  
High Flow ◽  
Nasal Cannula ◽  
Blood Oxygen ◽  
High Flow Nasal Cannula ◽  
Advanced Airway ◽  
Total Body ◽  
Total Body Oxygen

Preoxygenation allows a margin of safety prior to establishing control of a patient’s airway. Effective preoxygenation is influenced by careful technique, respiratory physiology, blood oxygen content, and total body oxygen consumption. Total body oxygen consumption is increased in the pregnant, pediatric, and obese populations, making maintenance of oxygenation more difficult during apnea. In addition to a standard facemask, advanced equipment such as high-flow nasal cannula, THRIVE, and various mask variants may be used. Positioning of a patient for advanced airway management affects preoxygenation, respiratory mechanics, and the conditions for establishing a definitive airway. The “triple airway support” maneuver consists of head extension, neck flexion, and protrusion of the mandibular teeth over the upper teeth; and provides effective mechanics for positive-pressure mask ventilation. Patients with potentially unstable cervical spines present additional challenges and, especially in emergency situations, require careful negotiation of priorities. Common maneuvers such as head tilt, jaw thrust, cricoid pressure, and manual in-line stabilization can cause motion in the unstable cervical spine with uncertain effects.  This review contains 7 figures, 5 tables, and 43 references. Keywords: preoxygenation, functional residual capacity, blood oxygen content, alveolar fraction of oxygen, total body oxygen consumption, high-flow nasal cannula, apneic oxygenation, sniffing position, triple airway support maneuver, manual in-line stabilization

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