Airway Management Training Should Include Advanced Life Support

Objectives. To examine the impact of endoscopy setting (hospital-based vs. office-based) on sedation/analgesia administration and to provide nationwide data on monitoring practices among Greek gastroenterologists in real-world settings. Material and Methods. A web-based survey regarding sedation/analgesia rates and monitoring practices during endoscopy either in a hospital-based or in an office-based setting was disseminated to the members of the Hellenic Society of Gastroenterology and Professional Association of Gastroenterologists. Participants were asked to complete a questionnaire, which consisted of 35 items, stratified into 4 sections: demographics, preprocedure (informed consent, initial patient evaluation), intraprocedure (monitoring practices, sedative agents’ administration rate), and postprocedure practices (recovery). Results. 211 individuals responded (response rate: 40.3%). Propofol use was significantly higher in the private hospital compared to the public hospital and the office-based setting for esophagogastroduodenoscopy (EGD) (85.8% vs. 19.5% vs. 10.5%, p<0.0001) and colonoscopy (88.2% vs. 20.1% vs. 9.4%, p<0.0001). This effect was not detected for midazolam, pethidine, and fentanyl use. Endoscopists themselves administered the medications in most cases. However, a significant contribution of anesthesiology sedation/analgesia provision was detected in private hospitals (14.7% vs. 2.8% vs. 2.4%, p<0.001) compared to the other settings. Only 35.2% of the private offices have a separate recovery room, compared to 80.4% and 58.7% of the private hospital- and public hospital-based facilities, respectively, while the nursing personnel monitored patients’ recovery in most of the cases. Participants were familiar with airway management techniques (83.9% with bag valve mask and 23.2% with endotracheal intubation), while 49.7% and 21.8% had received Basic Life Support (BLS) and Advanced Life Support (ALS) training, respectively. Conclusion. The private hospital-based setting is associated with higher propofol sedation administration both for EGD and for colonoscopy. Greek endoscopists are adequately trained in airway management techniques.

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Factors Influencing Successful Intubation in the Prehospital Setting

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00042138 ◽

1995 ◽

Vol 10 (4) ◽

pp. 259-264 ◽

Cited By ~ 56

Author(s):

James V. Doran ◽

Bartholomew J. Tortella ◽

Walter J. Drivet ◽

Robert F. Lavery

Keyword(s):

Airway Management ◽

Endotracheal Intubation ◽

Life Support ◽

Advanced Life Support ◽

High Volume ◽

Success Rates ◽

Structured Interviews ◽

Technical Problems ◽

Patients Âgés ◽

Prehospital Airway Management

AbstractObjective:To explore the determinants influencing oral/nasal endotracheal intubation (OETI/NETI) and determine which cognitive, therapeutic, and technical interventions may assist prehospital airway management.Design, Setting, and Participants:Prospective review of run reports and structured interviews of paramedics involved in OETI/NETI attempts were conducted in a high-volume, inner-city, advanced life support (ALS) system during an eight-month period (July 1991 to February 1992). Data were abstracted from run reports, and paramedics were asked in structured interviews to describe difficulties in OETI/NETI attempts.Results:Of 236 patients studied, 88% (208) were intubated successfully. Success/failure rate was not related statistically to patients' ages (p = 0. 78), medical or trauma complaint (89% vs 85%, p = 0.35), oral versus nasal route (88% vs 85%, p = 0.38), care time (scene + transport times: success, 18 minutes; failure, 20 minutes, p = 0.30), paramedic seniority (p = 0.13), or number of attempts per paramedic (p >0.05). Increased level of consciousness (LOC) was associated with decreased success rate (p = 0.04). Paramedics reported difficulties in endotracheal intubation (ETI) attempts in 110 (46.6%) of patients. Factors reported to increase ETI difficulty were: 1) technical problems (35.6%); 2) mechanical problems (15.6%); and 3) combative patients (12.7%).Conclusions:Oral endotracheal intubation and NETI success rates identified in this study are similar to those described in the literature, although innovative strategies could be used to facilitate prehospital airway management. Many of the factors found to increase ETI difficulty could be ameliorated by the administration of paralytic agents, that is, for combative patients. Focused training in cadaver and animal labs coupled with recurrence training in the operating suites should be used on a regular basis to decrease difficulties in visualization. Interventions directed at alleviating mechanical difficulties that should be explored include new-to-the-field techniques, such as retrograde intubation, fiber-optic technology, and surgical tracheal access.

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The Effects of Pediatric Advanced Life Support Guidelines on Pediatric Trauma Airway Management

Pediatric Emergency Care ◽

10.1097/pec.0000000000000759 ◽

2016 ◽

Vol 32 (8) ◽

pp. 499-503 ◽

Cited By ~ 3

Author(s):

Jana Sperka ◽

Sheila J. Hanson ◽

Raymond G. Hoffmann ◽

Mahua Dasgupta ◽

Michael T. Meyer

Keyword(s):

Airway Management ◽

Life Support ◽

Pediatric Trauma ◽

Advanced Life Support ◽

Support Guidelines

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The 2-year experience of new simulation-based airway management training protocol for junior physicians – Advanced Airway Life Support in Taiwan

Simulation in Healthcare The Journal of the Society for Simulation in Healthcare ◽

10.1097/01266021-200600120-00013 ◽

2006 ◽

Vol 1 (2) ◽

pp. 95

Author(s):

Pin-Tarng Chen ◽

Ying-Che Huang ◽

Huey-Wen Yien ◽

Cho-Yu Chan ◽

Cheng-Deng Kuo ◽

...

Keyword(s):

Airway Management ◽

Life Support ◽

Management Training ◽

Advanced Airway ◽

Simulation Based ◽

Training Protocol

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Abstract 351: Predictors of Neurological Outcome After Out-of-Hospital Cardiac Arrest With Ventricular Fibrillation Witnessed by Emergency Medical Service P.ersonnel., JCS-ReSS Study

Circulation ◽

10.1161/circ.138.suppl_2.351 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Katsutaka Hashiba ◽

Yoshio Tahara ◽

Kazuo Kimura ◽

Tsutomu Endo ◽

Kouichi Tamura ◽

...

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Airway Management ◽

Neurological Outcome ◽

Medical Service ◽

Life Support ◽

Advanced Life Support ◽

Advanced Airway ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Background: Effective advanced life support is one of the important link in the chain of survival. In Japan, the emergency medical service (EMS) personnel can perform defibrillation, advanced airway management, intravenous access and administration of epinephrine as an advanced life support intervention for the treatment of out-of-hospital cardiac arrest (OHCA). However, whether these interventions performed by EMS improves neurological outcomes remains unclear. Objective: To evaluate predictors of favorable neurological outcome in patients suffering OHCA with ventricular fibrillation (VF) witnessed by an EMS personnel. Methods: The Fire and Disaster Management Agency (FDMA) of Japan developed a nationwide database of a prospective population-based cohort using an Utstein-style template for OHCA patients since January 2005. To evaluate data after the publication of Guideline2010, data from January 2011 to December 2015 of this database was used for the current analysis. A multivariate logistic-regression analysis was performed to assess factors associated with favorable neurological outcome (defined as Cerebral Performance Category 1 or 2) 1 month after cardiac arrest. Results: Of the 629,471 patients documented for the study period, 2,301 adult patients with an OHCA of cardiac origin and VF for the initial rhythm witnessed by an EMS personnel were included in the present analysis. The overall mortality was 49.6%. Rate of return of spontaneous circulation and favorable neurological outcome were 53.4% and 44.8%, respectively. High age (OR0.387, 95%CI0.316-0.472, p<0.001), delayed defibrillation (OR0.598, 95%CI0.493-0.723, p<0.001), advanced airway management (OR0.305, 95%CI0.223-0.413, p<0.001), administration of epinephrine (OR0.356, 95%CI0.213-0.585, p<0.001) and multiple attempts of defibrillation (OR0.484, 95%CI0.402-0.582, p<0.001) were negatively associated with favorable neurological outcome. Conclusion: In patients with VF witnessed by EMS personnel, resuscitation efforts should simply focus on early defibrillation and CPR without advanced interventions.

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Performing newborn life support in advance of neonatal advanced life support course—back to basics?

European Journal of Pediatrics ◽

10.1007/s00431-020-03917-9 ◽

2021 ◽

Author(s):

Tim Hundscheid ◽

Jos Bruinenberg ◽

Jeroen Dudink ◽

Rogier de Jonge ◽

Marije Hogeveen

Keyword(s):

Heart Rate ◽

Airway Management ◽

Life Support ◽

Advanced Life Support ◽

Substantial Part ◽

Test Scenario ◽

Chi Squared ◽

Support Skills ◽

Training Programmes ◽

Support Guidelines

AbstractIn this retrospective analysis, the Newborn Life Support (NLS) test scenario performance of participants of the Dutch Neonatal Advanced Life Support (NALS) course was assessed. Characteristics of participants and total amount of failures were collected. Failures were subdivided in (1) errors of omission; (2) errors of commission; and (3) unspecified if data was missing. Pearson’s chi-squared test was used to assess differences between participant groups. In total, 23 out of 86 participants (27%) failed their NLS test scenario. Life support course instructors in general (20/21) passed their test scenario more often compared to other participants (43/65) (p = 0.008). In total 110 fail items were recorded; the most common errors being not assessing heart rate (error of omission) (n = 47) and inadequate performance of airway management (error of commission) (n = 24).Conclusion: A substantial part of NALS participants failed their NLS test scenario. Errors of omission could be reduced by the availability of a checklist/NLS algorithm. Life support course instructors possibly make less errors of commission due to retention of skills by teaching these skills at least twice a year. Therefore, our study suggests that neonatal basic life support skills should be retained by local assurance of training programmes. What is Known:• Retention of skills after life support courses decreases after three months.• Adherence to newborn life support guidelines is suboptimal. What is New:• NLS performance is suboptimal in participants for advanced neonatal life support.• Most common failures are not assessing heart rate and inadequate airway management.

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Cardiopulmonary resuscitation (CPR) during spaceflight - a guideline for CPR in microgravity from the German Society of Aerospace Medicine (DGLRM) and the European Society of Aerospace Medicine Space Medicine Group (ESAM-SMG)

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00793-y ◽

2020 ◽

Vol 28 (1) ◽

Author(s):

Jochen Hinkelbein ◽

Steffen Kerkhoff ◽

Christoph Adler ◽

Anton Ahlbäck ◽

Stefan Braunecker ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Airway Management ◽

Life Support ◽

Advanced Life Support ◽

Medical Emergency ◽

Supraglottic Airway ◽

Chest Compressions ◽

Aerospace Medicine ◽

International Group ◽

The Earth

Abstract Background With the “Artemis”-mission mankind will return to the Moon by 2024. Prolonged periods in space will not only present physical and psychological challenges to the astronauts, but also pose risks concerning the medical treatment capabilities of the crew. So far, no guideline exists for the treatment of severe medical emergencies in microgravity. We, as a international group of researchers related to the field of aerospace medicine and critical care, took on the challenge and developed a an evidence-based guideline for the arguably most severe medical emergency – cardiac arrest. Methods After the creation of said international group, PICO questions regarding the topic cardiopulmonary resuscitation in microgravity were developed to guide the systematic literature research. Afterwards a precise search strategy was compiled which was then applied to “MEDLINE”. Four thousand one hundred sixty-five findings were retrieved and consecutively screened by at least 2 reviewers. This led to 88 original publications that were acquired in full-text version and then critically appraised using the GRADE methodology. Those studies formed to basis for the guideline recommendations that were designed by at least 2 experts on the given field. Afterwards those recommendations were subject to a consensus finding process according to the DELPHI-methodology. Results We recommend a differentiated approach to CPR in microgravity with a division into basic life support (BLS) and advanced life support (ALS) similar to the Earth-based guidelines. In immediate BLS, the chest compression method of choice is the Evetts-Russomano method (ER), whereas in an ALS scenario, with the patient being restrained on the Crew Medical Restraint System, the handstand method (HS) should be applied. Airway management should only be performed if at least two rescuers are present and the patient has been restrained. A supraglottic airway device should be used for airway management where crew members untrained in tracheal intubation (TI) are involved. Discussion CPR in microgravity is feasible and should be applied according to the Earth-based guidelines of the AHA/ERC in relation to fundamental statements, like urgent recognition and action, focus on high-quality chest compressions, compression depth and compression-ventilation ratio. However, the special circumstances presented by microgravity and spaceflight must be considered concerning central points such as rescuer position and methods for the performance of chest compressions, airway management and defibrillation.

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An Analysis of Invasive Airway Management in a Suburban Emergency Medical Services System

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00039340 ◽

1992 ◽

Vol 7 (2) ◽

pp. 121-126 ◽

Cited By ~ 56

Author(s):

Thomas J. Krisanda ◽

David R. Eitel ◽

Dean Hess ◽

Robert Ormanoski ◽

Robert Bernini ◽

...

Keyword(s):

Airway Management ◽

Life Support ◽

Advanced Life Support ◽

Blocking Agent ◽

Neuromuscular Blocking ◽

Successful Intubation ◽

Success Rates ◽

Altered Level ◽

Emergency Medical ◽

Significant Difference

AbstractIntroduction:Airway management is the most critical and potentially life-saving intervention performed by emergency medical service (EMS) providers. Invasive airway management often is required in non-cardiac-arrest patients who are combative or otherwise uncooperative. The success of prehospital invasive airway management in this patient population was evaluated.Methods:A retrospective review was undertaken of the records of all such patients requiring endotracheal intubation over a three-year period (1987–1989). The study population included 278 patients enrolled by five advanced life support (ALS) units serving a suburban population of 425,000. Field trip sheets were reviewed for diagnosis, intubation method and success, number of intubation attempts, provider experience, reasons for unsuccessful intubations, and complications.Results:A total of 394 invasive airway management attempts were performed on 278 patients. The overall successful intubation rate was 75% (41 % orotracheal, 52% nasotracheal, 7% other or unknown). The most common diagnoses were COPD and pulmonary edema (30%) and trauma (24%). Experienced providers were successful on the first attempt in 57% of cases compared to 50% by inexperienced providers (p=.24). Multiple intubation attempts were required in 33% of the patients. There was no statistically significant difference in success rates between the orotracheal and nasotracheal methods (p=.51). The most common reason for unsuccessful intubation was altered level of consciousness. Complications occurred with 7% of successful attempts and in 18% of unsuccessful attempts (p<.001). Forty-six percent of the patients who were not intubated successfully in the field and required intubation in the emergency department (ED) received a neuromuscular blocking agent prior to successful intubation.Conclusion:Prehospital providers can intubate a high but improvable proportion of non-cardiac-arrested patients by both the orotracheal and nasotracheal routes. The use of pharmacologic adjuncts to facilitate the prehospital intubation of selected, non-cardiac-arrested patients is a promising adjunct that needs further evaluation.

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