First-pass intubation success rate during rapid sequence induction of prehospital anaesthesia by physicians versus paramedics

2015 ◽  
Vol 22 (6) ◽  
pp. 391-394 ◽  
Author(s):  
Joost Peters ◽  
Bas van Wageningen ◽  
Ilze Hendriks ◽  
Ruud Eijk ◽  
Michael Edwards ◽  
...  
2020 ◽  
Author(s):  
Wenjun Zhu ◽  
Yuchen Zhang ◽  
Jingyu Shi ◽  
Xiaoqin Wang ◽  
Renjiao Li ◽  
...  

Abstract Background: Nasal insertion is the preferred method in flexible bronchoscopy; however, the relatively narrow nasal cavity increases the difficulty of bronchoscope insertion. The aim of the study was to investigate the advantages of a prior nasal cavity probe during flexible bronchoscopy and to investigate whether this novel method could reduce the complications associated with flexible bronchoscopy.Methods: This prospective randomized controlled trial was conducted in a tertiary hospital between May 2020 and October 2020. Three hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups: a control group, a simple cotton bud detection group (CD group), and an adrenaline detection group (AD group). The outcomes were the time to pass the glottis, the first-pass intubation success rate, and postoperative complications, especially nasal bleeding.Results: In total, 189 men and 111 women were enrolled in the study, with a mean age of 55.69 ± 12.86 years. The operation time was longer in the control group (24 [14.25-45.75] s) than in the CD group (19.5 [12.25-32.75] s). Compared with that in the CD group, the first-pass intubation success rate was significantly lower in the control group (p<0.05). There was no difference in nasal bleeding between the control group and the CD group (p=0.506). Nasal bleeding after flexible bronchoscopy was more common in the CD group than in the AD group (p=0.005); however, there was no significant between-group difference in hemostatic use (p=0.245). Conclusions: Use of a prior nasal cavity probe during flexible bronchoscopy can significantly reduce the time to pass the nasal cavity, improve the first-pass intubation success rate, and reduce postoperative nasal bleeding. Nasal detection is recommended as a time-saving procedure for patients undergoing flexible bronchoscopy. Trial registration: ChiCTR2000032668, 6th May.2020.


JAMA ◽  
2019 ◽  
Vol 322 (23) ◽  
pp. 2303 ◽  
Author(s):  
Bertrand Guihard ◽  
Charlotte Chollet-Xémard ◽  
Philippe Lakhnati ◽  
Benoit Vivien ◽  
Claire Broche ◽  
...  

2017 ◽  
Vol 24 (1) ◽  
pp. 77 ◽  
Author(s):  
Joost Peters ◽  
Bas Van Wageningen ◽  
Ilze Hendriks ◽  
Ruud Eijk ◽  
Michael Edwards ◽  
...  

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Latha Naik ◽  
Neerja Bhardwaj ◽  
Indu Mohini Sen ◽  
Rakesh V. Sondekoppam

Introduction. The study aims to test whether flexible silicone tubes (FST) improve performance and provide similar intubation success through I-Gel as compared to ILMA. Our trial is registered in CTRI and the registration number is “CTRI/2016/06/006997.”Methods. One hundred and twenty ASA status I-II patients scheduled for elective surgical procedures needing tracheal intubation were randomised to endotracheal intubation using FST through either I-Gel or ILMA. In the ILMA group (n=60), intubation was attempted through ILMA using FST and, in the I-Gel group (n=60), FST was inserted through I-Gel airway.Results. Successful intubation was achieved in 36.67% (95% CI 24.48%–48.86%) on first attempt through I-Gel (n=22/60) compared to 68.33% (95% CI 56.56%–80.1%) in ILMA (n=41/60) (p=0.001). The overall intubation success rate was also lower with I-Gel group [58.3% (95% CI 45.82%–70.78%);n=35] compared to ILMA [90% (95% CI 82.41%–97.59%);n=54] (p<0.001). The number of attempts, ease of intubation, and time to intubation were longer with I-Gel compared to ILMA. There were no differences in the other secondary outcomes.Conclusion. The first pass success rate and overall success of FST through an I-Gel airway were inferior to those of ILMA.


2017 ◽  
Vol 32 (6) ◽  
pp. 621-624 ◽  
Author(s):  
Ryan Hodnick ◽  
Tony Zitek ◽  
Kellen Galster ◽  
Stephen Johnson ◽  
Bryan Bledsoe ◽  
...  

AbstractObjectiveThe primary goal of this study was to compare paramedic first pass success rate between two different video laryngoscopes and direct laryngoscopy (DL) under simulated prehospital conditions in a cadaveric model.MethodsThis was a non-randomized, group-controlled trial in which five non-embalmed, non-frozen cadavers were intubated under prehospital spinal immobilization conditions using DL and with both the GlideScope Ranger (GL; Verathon Inc, Bothell, Washington USA) and the VividTrac VT-A100 (VT; Vivid Medical, Palo Alto, California USA). Participants had to intubate each cadaver with each of the three devices (DL, GL, or VT) in a randomly assigned order. Paramedics were given 31 seconds for an intubation attempt and a maximum of three attempts per device to successfully intubate each cadaver. Confirmation of successful endotracheal intubation (ETI) was confirmed by one of the six on-site physicians.ResultsSuccessful ETI within three attempts across all devices occurred 99.5% of the time overall and individually 98.5% of the time for VT, 100.0% of the time for GL, and 100.0% of the time for DL. First pass success overall was 64.4%. Individually, first pass success was 60.0% for VT, 68.8% for GL, and 64.5% for DL. A chi-square test revealed no statistically significant difference amongst the three devices for first pass success rates (P=.583). Average time to successful intubation was 42.2 seconds for VT, 38.0 seconds for GL, and 33.7 for seconds for DL. The average number of intubation attempts for each device were as follows: 1.48 for VT, 1.40 for GL, and 1.42 for DL.ConclusionThe was no statistically significant difference in first pass or overall successful ETI rates between DL and video laryngoscopy (VL) with either the GL or VT (adult).HodnickR, ZitekT, GalsterK, JohnsonS, BledsoeB, EbbsD. A comparison of paramedic first pass endotracheal intubation success rate of the VividTrac VT-A 100, GlideScope Ranger, and direct laryngoscopy under simulated prehospital cervical spinal immobilization conditions in a cadaveric model. Prehosp Disaster Med. 2017;32(6):621–624.


Author(s):  
Jakob Zeuchner ◽  
Jonas Graf ◽  
Louise Elander ◽  
Jessica Frisk ◽  
Mats Fredrikson ◽  
...  

Author(s):  
Pascale Avery ◽  
Sarah Morton ◽  
James Raitt ◽  
Hans Morten Lossius ◽  
David Lockey

Abstract Background Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. Most of the key aspects of traditional RSI – training, technique, drugs and equipment have been challenged and often significantly changed since the procedure was first described. Alterations have been made to improve the safety and quality of the intervention while retaining the principles of rapidly securing a definitive airway and avoiding gastric aspiration. RSI is no longer achieved by an anaesthetist alone and can be delivered safely in a variety of settings, including in the pre-hospital environment. Conclusion The conduct of RSI in current emergency practice is far removed from the original descriptions of the procedure. Despite this, the principles – rapid delivery of a definitive airway and avoiding aspiration, are still highly relevant and the indications for RSI remain relatively unchanged.


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