scholarly journals Laryngeal mask versus endotracheal intubation for pre-hospital emergency airway management: a meta-analysis of randomized control studies

2019 ◽  
Author(s):  
Hao Li ◽  
Ming-da Duan ◽  
Yun-liang Zhang ◽  
Shao-hua You ◽  
Yu-xiang Song ◽  
...  
Keyword(s):  
Adverse Events ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Meta Analysis ◽  
Blood Gas ◽  
Success Rates ◽  
Hospital Emergency ◽  
Laryngeal Masks ◽  
Emergency Airway Management ◽  
Emergency Airway

Abstract Background : Pre-hospital emergency airway management plays an important role in pre-hospital care. Laryngeal masks are increasingly employed for the airway management of pre-hospital critical patients and have achieved promising results. Although several randomized controlled trials have reported benefits, the efficacy of laryngeal masks in pre-hospital emergency airway management compared to endotracheal intubation have not been systematically reviewed. Methods: Electronic databases (PubMed, Cochrane Library, Embase, Scopus and CNKI) were searched up to April 2019 for related randomized studies. Outcome indicators included overall intubation success rates, the success rates of the first intubation, insertion time, resuscitation efficiency rates, SpO2 rise time, the blood gas index and adverse events. Two investigators selected the trials, extracted the data according to inclusion and exclusion criteria, and assessed the quality of the literature according to the Jada score. The meta-analysis was performed using stata14.0 software. Results: We included 31 human studies. Compared to endotracheal intubation, the application of laryngeal mask for pre-hospital emergencies enhanced the resuscitation efficiency rates [RR=1.20, 95% CI (1.06, 1.35), P<0.001], improved the success of first intubation [RR=1.29, 95% CI (1.18, 1.40), P<0.001] and the patients’ blood gas index, shortened the insertion and SpO2 rise times [SMD=-3.48, 95% CI (-4.17, -2.80), P < 0.001; -2.19, 95% CI (-3.06, -1.32), P < 0.001] and reduced the incidence of adverse events [RR=0.41, 95% CI (0.30, 0.57, P<0.001]. All results were stable and statistically significant. Conclusions: Laryngeal masks could quickly and effectively improve patient ventilation in pre-hospital emergencies, highlighting its utility for clinical application.

scholarly journals Laryngeal mask versus endotracheal intubation for pre-hospital emergency airway management: a meta-analysis of randomized control studies

2019 ◽  
Author(s):  
Hao Li ◽  
Ming-da Duan ◽  
Yun-liang Zhang ◽  
Shao-hua You ◽  
Yu-xiang Song ◽  
...  
Keyword(s):  
Airway Management ◽  
Endotracheal Intubation ◽  
Meta Analysis ◽  
Blood Gas ◽  
Success Rates ◽  
Hospital Emergency ◽  
Laryngeal Masks ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Ventilation Efficiency

Abstract Background : Pre-hospital emergency airway management plays an important role in pre-hospital care. Laryngeal masks are increasingly employed for the airway management of pre-hospital critical patients and have achieved promising results. Although several randomized controlled trials have reported benefits, the efficacy of laryngeal masks in pre-hospital emergency airway management compared to endotracheal intubation have not been systematically reviewed. Methods: Electronic databases (PubMed, Cochrane Library, Embase, Scopus and CNKI) were searched up to April 2019 for related randomized studies. Outcome indicators included overall intubation success rates, the success rates of the first intubation, insertion time, ventilation efficiency rates, SpO2 rise time, the blood gas index and adverse events. Two investigators selected the trials, extracted the data according to inclusion and exclusion criteria, and assessed the quality of the literature according to the Jada score. The meta-analysis was performed using stata14.0 software. Results: We included 31 human studies. Compared to endotracheal intubation, the application of laryngeal mask for pre-hospital emergencies enhanced the ventilation efficiency rates [RR=1.20, 95% CI (1.06, 1.35), P<0.001], improved the success of first intubation [RR=1.29, 95% CI (1.18, 1.40), P<0.001] and the patients’ blood gas index, shortened the insertion and SpO2 rise times [SMD=-3.48, 95% CI (-4.17, -2.80), P < 0.001; -2.19, 95% CI (-3.06, -1.32), P < 0.001] and reduced the incidence of adverse events [RR=0.41, 95% CI (0.30, 0.57, P<0.001]. All results were stable and statistically significant. Conclusions: Laryngeal masks could quickly and effectively improve patient ventilation in pre-hospital emergencies, highlighting its utility for clinical application.

scholarly journals Laryngeal mask versus endotracheal intubation for pre-hospital emergency airway management: a meta-analysis of randomized manikin and human studies

2019 ◽  
Author(s):  
Hao Li ◽  
Ming-da Duan ◽  
Yun-liang Zhang ◽  
Shao-hua You ◽  
Yu-xiang Song ◽  
...  
Keyword(s):  
Airway Management ◽  
Endotracheal Intubation ◽  
Meta Analysis ◽  
Human Studies ◽  
Laryngeal Mask ◽  
Insertion Time ◽  
Success Rates ◽  
Hospital Emergency ◽  
Laryngeal Masks ◽  
Emergency Airway

Abstract Background Pre-hospital emergency airway management plays an important role in pre-hospital care. Laryngeal masks are increasingly employed for the airway management of pre-hospital critical patients and have achieved promising results. Although several randomized controlled trials have reported benefits, the efficacy of laryngeal masks in pre-hospital emergency airway management compared to endotracheal intubation have not been systematically reviewed.Methods Electronic databases (PubMed, Cochrane Library, Embase, Scopus and CNKI) were searched up to April 2019 for related randomized studies. Outcome indicators were overall intubation success rates, success rates of the initial intubation, insertion time, ventilation efficiency rates, SpO2 rise time and blood gas index. Two investigators selected the trials, extracted the data according to inclusion and exclusion criteria, and assessed the quality of the literature according to the Jada score. The meta-analysis was performed using stata14.0 software.Results We included 9 randomized manikin studies and 31 human studies. Meta-analysis of the manikin studies showed that the overall intubation success rates of the laryngeal mask group [RR=1.10, 95% CI (1.02, 1.18), P<0.05] and the success rates of first intubation [RR=1.25, 95% CI (1.01, 1.55), P <0.05] were significantly higher than the endotracheal intubation group. The insertion time of the laryngeal mask group was also significantly shorter [SMD = -1.53, 95% CI (-1.88, -1.17), P <0.05]. In human studies, excluding the success rates of first intubation and insertion time, the laryngeal mask was superior to endotracheal intubation and improved the patients’ blood gas index and shortened the SpO2 rise time. All the results were statistically significant.Conclusions Compared to endotracheal intubation, laryngeal masks could quickly and effectively improve patient ventilation in pre-hospital emergencies, highlighting its utility for clinical application .

What Is the Minimum Training Required for Successful Cricothyroidotomy?

2003 ◽  
Vol 98 (2) ◽  
pp. 349-353 ◽  
Author(s):  
David T. Wong ◽  
Atul J. Prabhu ◽  
Margarita Coloma ◽  
Ngozi Imasogie ◽  
Frances F. Chung
Keyword(s):  
Informed Consent ◽  
Airway Management ◽  
Success Rate ◽  
Success Rates ◽  
Skill Retention ◽  
Clinical Correlates ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Demonstration Video

Background A correctly performed cricothyroidotomy may be lifesaving in a cannot-ventilate, cannot-intubate situation. However, many practicing anesthesiologists do not have experience with cricothyroidotomy. The purpose of this study was to determine the minimum training required to perform cricothyroidotomy in 40 s or less in mannequins. Methods After informed consent, participants were shown a demonstration video and asked to perform 10 consecutive cricothyroidotomy procedures on a mannequin using a preassembled percutaneous dilational cricothyroidotomy set. Each attempt was timed from skin palpation to lung insufflation. Cricothyroidotomy was considered successful if it was performed in 40 s or less, and the cricothyroidotomy time was considered to have plateaued when there were no significant reductions in cricothyroidotomy times in three consecutive attempts. Results One hundred two anesthesiologists participated in the study. There was a significant reduction of cricothyroidotomy times over the 10 attempts (P &lt; 0.0001) and between three consecutive attempts until the fourth attempt (P &lt; 0.03). The cricothyroidotomy times plateaued by the fourth attempt, while the success rate plateaued at the fifth attempt (94, 96, 96, and 96% at the fourth, fifth, sixth, and seventh attempts, respectively). Conclusion Practice on mannequins leads to reductions in cricothyroidotomy times and improvement in success rates. By the fifth attempt, 96% of participants were able to successfully perform the cricothyroidotomy in 40 s or less. While clinical correlates are not known, the authors recommend that providers of emergency airway management be trained on mannequins for at least five attempts or until their cricothyroidotomy time is 40 s or less. The most appropriate retraining intervals have yet to be determined for optimal cricothyroidotomy skill retention.

scholarly journals Insertion Success of the Laryngeal Tube in Emergency Airway Management

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Michael Bernhard ◽  
André Gries ◽  
Alexandra Ramshorn-Zimmer ◽  
Volker Wenzel ◽  
Bjoern Hossfeld
Keyword(s):  
Airway Management ◽  
Laryngeal Tube ◽  
Severely Injured ◽  
Success Rates ◽  
Severely Injured Patients ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Emergency Situations ◽  
First Pass ◽  
Injured Patients

Background. Emergency airway management (AM) is a priority when resuscitating critically ill or severely injured patients. The goal of this study was to determine the success rates of LT insertion during AM.Methods. Studies that included LT first-pass insertion (FPI) and overall-pass insertion (OPI) success by emergency medical services and in-hospital providers performing AM for emergency situations as well as for scheduled surgery published until July 2014 were searched systematically in Medline.Results. Data of 36 studies (n= 1,897) reported a LT FPI success by physicians of 82.5% with an OPI success of 93.6% (p<0.001). A cumulative analysis of all 53 studies (n= 3,600) led to FPI and OPI success of 80.1% and 92.6% (p<0.001), respectively. The results of 26 studies (n= 2,159) comparing the LT with the laryngeal mask airway (LMA) demonstrated a FPI success of 77.0 versus 78.7% (p=0.36) and an OPI success of 92.2 versus 97.7% (p<0.001).Conclusion. LT insertion failed in the first attempt in one out of five patients, with an overall failure rate in one out of 14 patients. When compared with the LT, the LMA had a cumulative 5.5% better OPI success rate.

scholarly journals Emergency airway management in a Singapore centre: A registry study

2021 ◽  
Vol 50 (1) ◽  
pp. 42-51
Author(s):  
Gene Wai Han Chan ◽  
Chew Yian Chai ◽  
Joy Su-Yue Teo ◽  
Calvin Kai En Tjio ◽  
Mui Teng Chua ◽  
...  
Keyword(s):  
Adverse Events ◽  
Airway Management ◽  
Difficult Airway ◽  
Rapid Sequence Induction ◽  
University Hospital ◽  
Rapid Sequence Intubation ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Rapid Sequence ◽  
Medical Indications

ABSTRACT Introduction: Intubations in the emergency department (ED) are often performed immediately without the benefit of pre-selection or the ability to defer. Multicentre observational data provide a framework for understanding emergency airway management but regional practice variation may exist. We aim to describe the intubation indications, prevalence of difficult airway features, peri-intubation adverse events and intubator characteristics in the ED of the National University Hospital, Singapore. Methods: We conducted a prospective observational study over a period of 31 months from 1 March 2016 to 28 September 2018. Information regarding each intubation attempt, such as indications for intubation, airway assessment, intubation techniques used, peri-intubation adverse events, and clinical outcomes, was collected and described. Results: There were 669 patients, with male predominance (67.3%, 450/669) and mean age of 60.9 years (standard deviation [SD] 18.1). Of these, 25.6% were obese or grossly obese and majority were intubated due to medical indications (84.8%, 567/669). Emergency physicians’ initial impression of difficult airway correlated with a higher grade of glottis view on laryngoscopy. First-pass intubation success rate was 86.5%, with hypoxia (11.2%, 75/669) and hypotension (3.7%, 25/669) reported as the two most common adverse events. Majority was rapid sequence intubation (67.3%, 450/669) and the device used was most frequently a video laryngoscope (75.6%, 506/669). More than half of the intubations were performed by postgraduate clinicians in year 5 and above, clinical fellows or attending physicians. Conclusion: In our centre, the majority of emergency intubations were performed for medical indications by senior doctors utilising rapid sequence intubation and video laryngoscopy with good ffirst-attempt success. Keywords: Difficult airway, emergency services, intubation, peri-intubation adverse events, rapid sequence induction

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