Should we continue using endotracheal tubes for cardiac arrest?

[Guest guest]

I though some of you might enjoy this ...

Hands-off time during insertion of six airway devices during cardiopulmonary

resuscitation: A randomised manikin trial.

Introduction

Cardiopulmonary resuscitation (CPR) guidelines recommend limiting interruptions

of chest compressions because prolonged hands-off (i.e., non-compression) time

compromises tissue perfusion. 2010 European Resuscitation Council guidelines

suggest that chest compressions should be paused less than 10 s during airway

device insertion.

Methods

With approval of the local ethics committee of the Medical University of Vienna

and written informed consent, we recruited 40 voluntary emergency medical

technicians, none of whom had advanced airway management experience. After a

standardised audio-visual lecture and practical demonstration, technicians

performed airway management with each six-airway devices (endotracheal tube,

Combitube, EasyTube, laryngeal tube, Laryngeal Mask Airway, and I-Gel) during

on-going chest compressions in a randomised sequence on a Resusci Anne Advanced

Simulator. Data were analysed using a mixed-effects model accounting for the

repeated measurements and pair-wise comparisons among the airway devices.

Results

The hands-off time associated with airway management using an endotracheal tube

(including all intubation attempts) was 48 s (95% confidence interval: 43–53).

The hands-off time for airway management using a laryngeal tube was 8.4

(3.4–16.4) s, Combitube 10.0 (4.9–15.1) s, EasyTube 11.4 (6.4–16.4) s, LMA 13.3

(8.2–18.3) s and for I-Gel 15.9 (10.8–20.9) s. Hands-off time was significantly

longer with the conventional endotracheal tube than with any of the other airway

systems. Only a third of the technicians successfully inserted an endotracheal

tube whereas all of them successfully positioned each supraglottic device.

Conclusion

Supraglottic devices appear to be a reasonable emergency airway management

strategy, even for inexperienced personnel.

Ruetzler, K., Nabecker, S., Wohlfarth, P., Priemayr, A., Frass, M., Kimberger,

O., Sessler, D. I.,& Roessler, B. (2011). Hands-off time during insertion of

six airway devices during cardiopulmonary resuscitation: A randomised manikin

trial. Resuscitation, 82(8), 1060-1063.

Kenny Navarro

Dallas

[Guest guest]

We use the King LT in our protocols for cardiac arrest for EMT level

providers. I have noticed when teaching across the US that the King LT is

utilized as a OPA; non-medics can deploy it. Off-shore rigs and remote area

primarily. The main thing regarding the King LT is proper placement - after

it is placed; until the stop hits the teeth, inflate the bladders and pull

back up to seat the large bladder against the base of the tongue and back of

mouth. I haven't come across someone inserting it wrong - I have seen the

zealous person pull it out even after the bladders have been inflated. This

can be prevented if the gel is not used - usually moist enough in the mouth

to allow insertion.

I don't think it is as effective as intubation, but I haven't seen a study.

I believe they are more effective than standard OPA or NPA because with the

large bladder, it decreases the dead air space that needs to be oxygenated.

From: texasems-l [mailto:texasems-l ] On

Behalf Of ryanthorsays

Sent: July 15, 2011 1:12 PM

To: texasems-l

Subject: Re: Should we continue using endotracheal tubes for

cardiac arrest?

That is interesting. I'm curious how much of a difference

It would make if the study was done with experienced medics. Probably allot

better I would guess; or hope. Could just use a King LT. Do any of you carry

the King LT in your bag?

>

> I though some of you might enjoy this ...

>

> Hands-off time during insertion of six airway devices during

cardiopulmonary resuscitation: A randomised manikin trial.

>

> Introduction

>

> Cardiopulmonary resuscitation (CPR) guidelines recommend limiting

interruptions of chest compressions because prolonged hands-off (i.e.,

non-compression) time compromises tissue perfusion. 2010 European

Resuscitation Council guidelines suggest that chest compressions should be

paused less than 10 s during airway device insertion.

>

> Methods

>

> With approval of the local ethics committee of the Medical University of

Vienna and written informed consent, we recruited 40 voluntary emergency

medical technicians, none of whom had advanced airway management experience.

After a standardised audio-visual lecture and practical demonstration,

technicians performed airway management with each six-airway devices

(endotracheal tube, Combitube, EasyTube, laryngeal tube, Laryngeal Mask

Airway, and I-Gel) during on-going chest compressions in a randomised

sequence on a Resusci Anne Advanced Simulator. Data were analysed using a

mixed-effects model accounting for the repeated measurements and pair-wise

comparisons among the airway devices.

>

> Results

>

> The hands-off time associated with airway management using an endotracheal

tube (including all intubation attempts) was 48 s (95% confidence interval:

43-53). The hands-off time for airway management using a laryngeal tube was

8.4 (3.4-16.4) s, Combitube 10.0 (4.9-15.1) s, EasyTube 11.4 (6.4-16.4) s,

LMA 13.3 (8.2-18.3) s and for I-Gel 15.9 (10.8-20.9) s. Hands-off time was

significantly longer with the conventional endotracheal tube than with any

of the other airway systems. Only a third of the technicians successfully

inserted an endotracheal tube whereas all of them successfully positioned

each supraglottic device.

>

> Conclusion

>

> Supraglottic devices appear to be a reasonable emergency airway management

strategy, even for inexperienced personnel.

>

> Ruetzler, K., Nabecker, S., Wohlfarth, P., Priemayr, A., Frass, M.,

Kimberger, O., Sessler, D. I.,& Roessler, B. (2011). Hands-off time during

insertion of six airway devices during cardiopulmonary resuscitation: A

randomised manikin trial. Resuscitation, 82(8), 1060-1063.

>

> Kenny Navarro

> Dallas

>