Does the type of out-of-hospital airway interfere with other cardiopulmonary resuscitation tasks?
ABSTRACT Out-of-hospital rescuers often perform tracheal intubation (TI) prior to other cardiopulmonary resuscitation (CPR) interventions. TI is a complex and error-prone procedure that may interfere with other key resuscitation tasks. We compared the effects of TI versus esophageal tracheal combitube (ETC) insertion on the accomplishment of other interventions during simulated cardiopulmonary resuscitation.
In this prospective trial using a human simulator, two-paramedic teams simulated resuscitation of a ventricular fibrillation cardiopulmonary arrest using standard Advanced Cardiac Life Support guidelines. In each of two trials, teams used either TI or ETC as the primary airway device. Following delivery of three rescue shocks, we measured time intervals to successful airway placement, intravenous (IV) line insertion, drug administration, delivery of fourth rescue shock and completion of all four tasks. We also measured the total time without chest compressions. We compared task completion times using non-parametric statistics (Wilcoxon signed-ranks test) with a Bonferroni-adjusted p-value of 0.008.
Twenty teams each completed two scenarios. Participants required a median of 172.5 s (IQR: 146.5-225.5) to accomplish all four tasks. Elapsed time to airway placement was significantly less for ETC than TI (median difference 26.5 s (IQR 13-44.5), p=0.002). Time without chest compressions was less for ETC than TI (median difference 8.5 s (IQR 2.5-23.5), p=0.005). There were no differences between ETC and TI in times to IV placement (median difference 23.5 s (IQR -20 to 61), p=0.11), drug delivery (39.5 s (IQR -18 to 63), p=0.07), delivery of fourth rescue shock (39.5 s (IQR -21.5 to 87.5), p=0.07) or completion of all four tasks (33 s (IQR -11 to 74.5), p=0.08).
Compared with TI, ETC reduced time to airway placement and time without chest compressions, but did not affect elapsed times to accomplish other interventions. Additional time differences may be realized if translated to clinical out-of-hospital conditions.
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ABSTRACT: The impact of prehospital intubation (PHI) in improving outcome of trauma patients has not been adequately evaluated in the developing countries. The present study analyzed the outcome of PHI versus emergency room intubation (ERI) among trauma patients in Qatar. Data were retrospectively reviewed for all intubated trauma patients between 2010 and 2011. Patients were classified according to location of intubation (PHI: Group-1 versus ERI: Group-2). Data were analyzed and compared. Out of 570 intubated patients; 482 patients (239 in group-1 and 243 in group-2) met the inclusion criteria with a mean age of 32 14.6 years Head injury (P = 0.003) and multiple trauma (P = 0.004) were more prevalent in group-1, whereas solid organ injury predominated in group-2 (P = 0.02). Group-1 had significantly higher mean injury severity scoring (ISS), lower Glasgow coma scale (GCS), greater head abbreviated injury score and longer activation, response, scene and total emergency medical services times. The mortality was higher in group-1 (53% vs. 18.5%; P = 0.001). Multivariate analysis showed that GCS [odds ratio (OR) 0.78, P = 0.005) and ISS (OR 1.12, P = 0.001) were independent predictors of mortality. PHI is associated with high mortality when compared with ERI. However, selection bias cannot be ruled out and therefore, PHI needs further critical assessment in Qatar.01/2014; 6(1):12-8. DOI:10.4103/1947-2714.125855
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ABSTRACT: Background Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest. Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time. The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality. Methods Consecutive adult patients who sustained an in-hospital cardiac arrest were enrolled in this prospective observational study. The quality of CPR was measured using the Q-CPR device (Phillips, UK) before and after an advanced airway device (Endotracheal tube [ET] or Laryngeal mask airway[LMA]) was inserted. Patients receiving only bag-mask ventilation were used as the control cohort. The primary outcome was no flow ratio (NFR). Secondary outcomes were chest compression rate, depth, compressions too shallow, compressions with leaning, ventilation rate, inflation time, change in impedance and time required to successfully insert airway device. Results One hundred patients were enrolled in the study (2008 to 2011). Endotracheal tube and LMA placement took similar durations (median 15.8s (IQR 6.8-19.4) vs LMA median 8.0s (IQR 5.5-15.9), p = 0.1). The use of an advanced airway was associated with improved no flow ratios (Endotracheal tube placement (n = 50) improved NFR from baseline median 0.24 (IQR 0.17 - 0.40 to 0.15) to (IQR 0.09-0.28), p = 0.012; LMA (n = 25) from median 0.28 (IQR 0.23 - 0.40) to 0.13 (IQR 0.11 - 0.19), p = 0.0001). There was no change in NFR in patients managed solely with bag valve mask (BVM) (n = 25) median 0.29 (IQR 0.18 - 0.59) versus median 0.26 (IQR 0.12 -0.37), p = 0.888). There was no significant difference in time taken to successfully insert the airway device between the two groups Conclusion The use of an advanced airway (ETT or LMA) during in-hospital cardiac arrest was associated with improved no flow ratio. Further studies are required to determine the effect of airway devices on overall patient outcomes.Resuscitation 07/2014; 85(7). DOI:10.1016/j.resuscitation.2014.02.018 · 3.96 Impact Factor
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ABSTRACT: Aviation terminology and thought processes are commonly applied to medicine. We further propose the adaptation of instrument flight terminology to emergency airway management including the aviation approach plate visual aid and replacement of the term "failed airway" with "missed airway," Copyright © 2015 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.Journal of Air Medical Transport 03/2015; 34(2):113-116. DOI:10.1016/j.amj.2014.12.011