The influence of different airway management strategies on chest compression fraction in simulated cardiopulmonary resuscitation, provided by paramedics: LMA Supreme versus Endotracheal Intubation and Combitube

Background: Common airway management strategies during cardiopulmonary resuscitation are bag- mask-valve ventilation followed by endotracheal intubation. Timing of endotracheal intubation is controversial. This study was designed to compare the effect of early vs late endotracheal intubation in terms of return of spontaneous circulation.Methods: This is an observational retrospective study done at tertiary center for the period of two years. The study population was inpatient, adult and pediatric with witnessed cardiac arrest in whom airway management was initially done with bag-valve-mask ventilation followed by endotracheal intubation. Timing of intubations were grouped into early and late with cut off time of five minutes and the groups were compared in terms of return of spontaneous circulation.Results: There were total of 193 patients included in the study. Early intubation was done in 114 patients (59.06%) and late intubation was done in 79 patients (40.94%). Mean time for early intubation was 3.11 minutes. Mean time for late intubation was 7.89 minutes. Seventy three patients (37.8%) attained sustained ROSC. Thirty five patients (30.7%) achieved ROSC in early intubation group while 38 patients (48.1%) attained sustained ROSC in late intubation group(p = 0.016). Conclusions: Early intubation during cardiopulmonary resuscitation was associated with lower rate of return of spontaneous circulation.

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Comparison of Different Intubation Methods in Difficult Airways during Simulated Cardiopulmonary Resuscitation with Continuous Chest Compression: A Randomized Cross-Over Manikin Trial

Emergency Medicine International ◽

10.1155/2019/7306204 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Togay Evrin ◽

Jacek Smereka ◽

Damian Gorczyca ◽

Szymon Bialka ◽

Jerzy Robert Ladny ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Airway Management ◽

Success Rate ◽

Endotracheal Intubation ◽

Chest Compression ◽

Macintosh Laryngoscope ◽

Intubation Time ◽

Intubation Success ◽

Intubation Success Rate ◽

Difficult Airways

Introduction. Airway management is one of key elements of resuscitation. Endotracheal intubation is still considered the gold standard for airway management during resuscitation. Aim. The aim of the study was to compare success rates and intubation time of different endotracheal intubation methods during emergency intubation with difficult airways in the conditions of cardiopulmonary resuscitation in a standardized manikin model. Methods. The study was designed as a prospective, randomized, cross-over simulation study. It involved 46 paramedics with at least 5 years of experience in Emergency Medical Service. The participants performed endotracheal intubation under difficult airway conditions during continuous chest compression, implemented with the LUCAS3 chest compression system. Three methods of tracheal intubation were applied: (1) standard Macintosh laryngoscope without a bougie stylet; (2) standard laryngoscope and a standard bougie stylet; (3) standard laryngoscope and a new bougie stylet. Results. The overall intubation success rate was 100% in the standard bougie and new bougie groups and lower (86.9%) when no bougie stylet was used (P=0.028). The intubation success rate with the 1st attempt equalled 91.3% for the new bougie group, 73.9% for standard bougie, and only 23.9% in the no-bougie group. The median intubation time was shortest in the new bougie group, where it amounted to 29 s (interquartile range [IQR]: 25–38); the time equalled 38s (IQR:31–44.5) in the standard bougie group and 47.5s (IQR:36–58) in the no-bougie group. The ease of use was lowest in the no-bougie group (85, IQR:63–88), average in the standard bougie group (44, IQR:30–51), and highest in the new bougie stylet group (32, IQR:19–41). Conclusion. In this manikin-based study, paramedics were able to perform endotracheal intubation with higher efficacy and in a shorter time using the new bougie stylet as compared with the standard bougie stylet.

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Difficult and failed intubation in the first 4000 incidents reported on webAIRS

Anaesthesia and Intensive Care ◽

10.1177/0310057x20957657 ◽

2020 ◽

Vol 48 (6) ◽

pp. 477-487

Author(s):

Yasmin Endlich ◽

Julie Lee ◽

Martin D Culwick

Keyword(s):

Body Mass Index ◽

Cardiopulmonary Resuscitation ◽

Airway Management ◽

Management Strategies ◽

Age Group ◽

Endotracheal Tube Cuff ◽

Failed Intubation ◽

Future Planning ◽

Tube Cuff ◽

Additional Equipment

A review of the first 4000 reports to the webAIRS anaesthesia incident reporting database was performed to analyse cases reported as difficult or failed intubation. Patient, task, caregiver and system factors were evaluated. Among the 4000 reports, there were 170 incidents of difficult or failed intubation. Difficult or failed intubation incidents were most common in the 40–59 years age group. More than half of cases were not predicted. A total of 40% involved patients with a body mass index >30 kg/m2 and 41% involved emergency cases. A third of the reports described multiple intubation attempts. Of the reports, 18% mentioned equipment problems including endotracheal tube cuff rupture, laryngoscope light failure, dysfunctional capnography and delays with availability of additional equipment to assist with intubation. Immediate outcomes included 40 cases of oxygen desaturation below 85%; of these cases, four required cardiopulmonary resuscitation. The majority of the incidents resulted in no harm or minor harm (45%). However, 12% suffered moderate harm, 3.5% severe harm and there were three deaths (although only one related to the airway incident). Despite advances and significant developments in airway management strategies, difficult and failed intubation still occurs. Although not all incidents are predictable, nor are all preventable, the information provided by this analysis might assist with future planning, preparation and management of difficult intubation.

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Effect on Chest Compression Fraction of Continuous Manual Compressions with Asynchronous Ventilations Using an i-gel® versus 30:2 Approach during Simulated Out-of-Hospital Cardiac Arrest: Protocol for a Manikin Multicenter Randomized Controlled Trial

Healthcare ◽

10.3390/healthcare9030354 ◽

2021 ◽

Vol 9 (3) ◽

pp. 354

Author(s):

Loric Stuby ◽

Laurent Jampen ◽

Julien Sierro ◽

Erik Paus ◽

Thierry Spichiger ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Airway Management ◽

Chest Compression ◽

User Satisfaction ◽

Controlled Trial ◽

Face Mask ◽

Spontaneous Circulation ◽

Multicenter Randomized Controlled Trial ◽

Hospital Cardiac Arrest

The optimal airway management strategy during cardiopulmonary resuscitation is uncertain. In the case of out-of-hospital cardiac arrest, a high chest compression fraction is paramount to obtain the return of spontaneous circulation and improve survival and neurological outcomes. To improve this fraction, providing continuous chest compressions should be more effective than using the conventional 30:2 ratio. Airway management should, however, be adapted, since face-mask ventilation can hardly be carried out while continuous compressions are administered. The early insertion of a supraglottic device could therefore improve the chest compression fraction by allowing ventilation while maintaining compressions. This is a protocol for a multicenter, parallel, randomized simulation study. Depending on randomization, each team made up of paramedics and emergency medical technicians will manage the 10-min scenario according either to the standard approach (30 compressions with two face-mask ventilations) or to the experimental approach (continuous manual compressions with early insertion of an i-gel® supraglottic device to deliver asynchronous ventilations). The primary outcome will be the chest compression fraction during the first two minutes of cardiopulmonary resuscitation. Secondary outcomes will be chest compression fraction (per cycle and overall), compressions and ventilations quality, time to first shock and to first ventilation, user satisfaction, and providers’ self-assessed cognitive load.

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Abstract 206: Effect of Airway Strategy Upon Chest Compression Quality in the Pragmatic Airway Resuscitation Trial

Circulation ◽

10.1161/circ.142.suppl_4.206 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Henry E Wang ◽

Xabier Jaureguibeitia ◽

Ahamed H Idris ◽

Unai Iruste ◽

Erik Gonzalez ◽

...

Keyword(s):

Airway Management ◽

Chest Compression ◽

Management Strategies ◽

Total Duration ◽

Quality Measures ◽

Median Number ◽

Laryngeal Tube ◽

Process Data ◽

Processing Techniques ◽

Signal Processing Techniques

Background: Chest compression (CC) quality is associated with improved out-of-hospital (OHCA) outcomes. Airway management efforts may adversely influence CC quality. We sought to compare the effects of initial laryngeal tube (LT) and initial endotracheal intubation (ETI) airway management strategies upon chest compression fraction (CCF), rate and interruptions in the Pragmatic Airway Resuscitation Trial (PART). Methods: We analyzed CPR process files collected from adult OHCA enrolled in PART. We used automated signal processing techniques (MATLAB) to identify and calculate CC quality measures. We defined a CC interruption as ≥3 second pause in chest compressions. We determined CC fraction, rate and interruptions (number and total duration) in 1-minute epochs for the entire resuscitation. We compared differences in CC quality between LT and ETI using t-tests. We repeated the analysis stratified by time before/after airway insertion as well as by successive 3-minute time segments. We also compared CC quality between single vs. multiple airway insertion attempts, as well as between BVM-only vs. ETI or LT. Results: Of 3,004 patients enrolled in PART, CPR process data were available for 1,996 (1,001 LT, 995 ETI). Mean resuscitation duration was: LT 22.6±10.8 min, ETI 25.3±11.3 min. Mean CC fraction (88% vs. 87%, p=0.045) and rate (114 vs. 114 bpm, p=0.59) were similar between LT and ETI. Median number of CC interruptions was similar between LT and ETI (11 vs. 12). Total CC interruption duration was lower for LT than ETI (160 vs. 181 sec, p=0.002); this difference was largest before airway insertion (56 vs. 78 sec, p=0.001). There were no differences in CC quality when stratified by 3-min time epochs. Total CC interruption duration was shorter for single than multiple airway insertion attempts (127 vs. 153 sec, p=0.005). Total CC interruption duration was shorter for BVM-only than LT or ETI (104 vs. 135 sec, p<0.001). Conclusion: In PART, compared with ETI, LT was associated with shorter total CC interruption duration but not other CC quality measures. Single-attempt airway insertion and BVM-only were associated with shorter total CC interruption duration. OHCA airway management may influence CC quality.

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Suicidal hanging patient with complete tracheal rupture

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918762870 ◽

2018 ◽

Vol 26 (2) ◽

pp. 124-126

Author(s):

Hyun Ho Jeong ◽

Kyoung Ho Choi ◽

Young Min Oh ◽

Yeon Young Kyong ◽

Se Min Choi ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Airway Management ◽

Endotracheal Intubation ◽

Tracheal Tube ◽

Attempted Suicide ◽

Fiberoptic Intubation ◽

Tracheal Rupture ◽

Airway Equipment

In attempted suicide, laryngotracheal rupture caused by hanging leads to rapid death at the scene or before arrival at hospital. The case presented here describes a patient with complete tracheal rupture from an attempted suicidal hanging who was successfully resuscitated. Pre-hospital providers transferred the patient to hospital without being aware of the possibility of airway damage. Cardiac arrest occurred shortly after arrival at hospital. During the cardiopulmonary resuscitation, endotracheal intubation was performed, and fortunately, the tracheal tube was located just below the ruptured trachea and thus enabled ventilation. For patients suspected of having airway damage at the pre-hospital stage, awareness of the patient’s condition and adequate airway management are important. The management of laryngotracheal rupture which suggests that for patients not adequately ventilated, immediate treatment with flexible fiberoptic intubation or tracheostomy is needed to secure the airway. Equipment and personnel at the receiving hospital need to be prepared for immediate treatment.

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Intraocular pressure response to airway management: Comparison between LMA Supreme® and C-MAC® videolaryngoscope in day care surgery

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v24i6.1400 ◽

2020 ◽

Vol 24 (6) ◽

Author(s):

Haramritpal Kaur ◽

Gurpreet Singh ◽

Jaipreet Singh ◽

Munish Dhawan ◽

Amandeep Singh ◽

...

Keyword(s):

Intraocular Pressure ◽

Airway Management ◽

Endotracheal Intubation ◽

Day Care ◽

Hemodynamic Parameters ◽

Day Care Surgery ◽

Group A ◽

Lma Supreme ◽

Group B ◽

Care Surgery

Background: Airway maintenance procedures during anesthesia are usually associated with a rise in intraocular pressure (IOP). This is an important issue especially in vulnerable patients. In the present study we compared the rise in IOP with two different group of airway devices i.e. Laryngeal mask airway Supreme (LMA-S) and endotracheal intubation (ETT) using C-MAC® videolaryngoscope (VLS). Methodology: The present study was conducted on 100 adult patients of ages >18 yrs, of either sex, belonging to American Society of Anesthesiologist (ASA) I and II, scheduled to undergo non-ophthalmic elective surgery under general anesthesia. Patients were divided into two equal groups of 50 each, Group A and Group B. In group A (n = 50), lubricated appropriate sized LMA-S was inserted and in Group B (n=50), lubricated appropriate sized ETT was inserted by an anesthesiologist using VLS. IOP was measured in right eye just before insertion of device and subsequently at 1 min, 3 min, 5 min and 10 min after insertion of device. Hemodynamic parameters were recorded along with IOP measurement. Results: Both the groups were comparable regarding demographic data (p > 0.05), ASA grade (p = 0.069), and Mallampati grade (MPG) (p = 0.646). Airway establishment time (p = 0.011) was significantly less with C-MAC VLS. IOP were comparable at all measurement times, e.g., 1 min (p = 0.216), 3 min (p = 0.093), 5 min (p = 0.859) and 10 min (p = 0.060) after insertion of each device. Hemodynamic parameters measured were also comparable between two groups (p > 0.05). Conclusion: Both LMA Supreme and intubation using C-MAC® videolaryngoscope are safe regarding rise in intraocular pressure. Both methods can be safely used for airway management in suitable patients. Key words: Airway; Anesthesia; Intraocular pressure; LMA; Endotracheal intubation Citation: Kaur H, Singh G, Singh J, Kaur, Dhawan M, Singh A. Intraocular pressure response to airway management: Comparison between LMA Supreme and C-MAC® videolaryngoscope in day care surgery. Anaesth. pain intensive care 2020;24(6):__ Received: 27 January 2020, Revised: 12 May 2020, Reviewed: 25 October 2020, Accepted: 27 October 2020

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