Does the type of out-of-hospital airway interfere with other cardiopulmonary resuscitation tasks?

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Resuscitation (Impact Factor: 4.17). 03/2007; 72(2):234-9. DOI: 10.1016/j.resuscitation.2006.06.028
Source: PubMed


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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    • "Mort and Schwartz et al.,[910] also demonstrated increased procedure related complication rates in PHI. Besides complications, PHI affects other resuscitation efforts and eventually delayed definitive care at the same time is life saving.[2223] The present study also shows increased scene time and total EMS time in patients intubated at the scene. "
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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.
    North American Journal of Medical Sciences 01/2014; 6(1):12-8. DOI:10.4103/1947-2714.125855
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    • "These results are comparable with those of Abo et. al [33]. The EasyTube performed comparable with the Combitube in our study. "
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    ABSTRACT: Introduction Airway management is an important component of cardiopulmonary resuscitation (CPR). Recent guidelines recommend keeping any interruptions of chest compressions as short as possible and not lasting more than 10 seconds. Endotracheal intubation seems to be the ideal method for establishing a secure airway by experienced providers, but emergency medical technicians (EMT) often lack training and practice. For the EMTs supraglottic devices might serve as alternatives. Methods 40 EMTs were trained in a 1-hour standardised audio-visual lesson to handle six different airway devices including endotracheal intubation, Combitube, EasyTube, I-Gel, Laryngeal Mask Airway and Laryngeal tube. EMTs performances were evaluated immediately after a brief practical demonstration, as well as after 1 and 3 months without any practice in between, in a randomised order. Hands-off time was pair-wise compared between airway devices using a repeated-measures mixed-effects model. Results Overall mean hands-off time was significantly (p<0.01) lower for Laryngeal tube (6.1s; confidence interval 5.2-6.9s), Combitube (7.9s; 95% CI 6.9-9.0s), EasyTube (8.8s; CI 7.3-10.3s), LMA (10.2s; CI 8.6-11.7s), and I-Gel (11.9s; CI 10.2-13.7s) compared to endotracheal intubation (39.4s; CI 34.0-44.9s). Hands-off time was within the recommended limit of 10s for Combitube, EasyTube and Laryngeal tube after 1 month and for all supraglottic devices after 3 months without any training, but far beyond recommended limits in all three evaluations for endotracheal intubation. Conclusion Using supraglottic airway devices, EMTs achieved a hands-off time within the recommended time limit of 10s, even after three months without any training or practice. Supraglottic airway devices are recommended tools for EMTs with lack of experience in advanced airway management.
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 02/2013; 21(1):10. DOI:10.1186/1757-7241-21-10 · 2.03 Impact Factor
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    ABSTRACT: Prior efforts have linked field endotracheal intubation (ETI) with increased out of hospital (OOH) time, but it is not clear if the additional time delay is due to the procedure, patient acuity, or transport distance. We sought to assess the difference in OOH time among trauma patients with and without OOH-ETI after accounting for distance and other clinical variables. Retrospective cohort analysis of trauma patients 14 years or older transported by ground or air to one of two Level 1 trauma centers from January 2000 to December 2003. Geographical data were probabilistically linked to trauma registry records for transport distance. Trauma registry OOH time (interval from 9-1-1 call to hospital arrival) was validated against a subset of linked ambulance records using Bland-Altman plots and tested by using the Spearman rank correlation coefficient. Based on the validation, the sample was restricted to patients with OOH time 100 minutes or less. The propensity for OOH-ETI was calculated by using field vital signs, demographics, mechanism, transport mode, comorbidities, Abbreviated Injury Scale head injury 3 or greater, injury severity score, blood transfusion, and major surgery. Multivariable linear regression (outcome = total OOH time) was used to assess the time increase (minutes) associated with OOH-ETI after adjusting for distance, propensity for OOH-ETI, and mode of transport. A total of 8,707 patients were included in the analysis, of which 570 (6.5%) were intubated in the field. Adjusted only for distance, OOH times averaged 6.1 minutes longer (95% CI 4.2-7.9) among patients intubated with RSI. After including other covariates, OOH time was 10.7 minutes (95% CI 7.7-13.8) longer among patients with RSI and 5.2 minutes (95% CI 2.2-8.1) longer among patients with conventional ETI. The time difference was greatest farther from the hospital. Patients with OOH-ETI have increased total OOH time, especially among those using RSI, even after accounting for distance and other clinical factors. Injured patients may benefit from airway management techniques that require less time for execution.
    Prehospital Emergency Care 04/2007; 11(2):224-9. DOI:10.1080/10903120701205208 · 1.76 Impact Factor
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