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]

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

>