Effect of Out-of-Hospital Pediatric Endotracheal Intubation on Survival and Neurological Outcome: A Controlled Clinical Trial

Gausche, Marianne; Lewis, Roger J.; Stratton, Samuel J.; Haynes, Bruce E.; Gunter, Carol S.; Goodrich, Suzanne; Poore, Pamela D.; McCollough, Maureen; Henderson, Deborah; Pratt, Franklin D; Seidel, James S.

doi:10.1097/00132586-200010000-00035

Cited by 168 publications

(258 citation statements)

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“…[5][6][7][8][9] EADs are the most common alternative to intubation in the field and likely the most common rescue airway device for failed intubation, other than bag-mask ventilation. The placement of an EAD can occur quickly, provides a means to oxygenate and ventilate a patient, and in many systems falls within the scope of practice for If the EAD does decrease cerebral perfusion-particularly in patients in a low-flow state-then many of these benefits of EAD placement may be outweighed by increased morbidity and mortality, although this has not been definitively demonstrated by research to date.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Evaluation of Carotid Artery Compression in Patients With Extraglottic Airway Devices in Place

White¹,

Braude²,

Lorenzo

et al. 2015

Academic Emergency Medicine

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Objectives: Extraglottic airway devices (EADs) are now commonly placed for airway management of critically ill or injured patients, particularly by emergency medical services providers in the out-ofhospital setting. Recent literature has suggested that EADs may cause decreased cerebral blood flow due to compression of the arteries of the neck by the devices' inflated cuffs. Methods:The authors identified a cohort of 17 patients presumed to be hemodynamically stable with EADs in place who underwent radiographic imaging of the neck. These studies were reviewed by a neuroradiologist to determine if mechanical compression of the carotid arteries was present.Results: None of the 17 cases reviewed had radiographically evident mechanical compression of the carotid artery. Conclusions:Until further studies are performed in which cerebral perfusion is evaluated prospectively in both hemodynamically stable and unstable human subjects, there is insufficicent evidence to recommend against the use of extraglottic airways in the emergency setting on the basis of carotid artery compression.ACADEMIC EMERGENCY MEDICINE 2015;22:636-638 © 2015 by the Society for Academic Emergency Medicine E xtraglottic airway devices (EADs) are commonly placed by emergency medical services (EMS) providers for airway management of critically ill or injured patients in the prehospital setting, and less commonly by physicians in the emergency department (ED). 1 Most EADs use an inflatable cuff in the hypopharynx to prevent airflow into the esophagus and to direct airflow into the trachea and lungs (see Figure 1). There exists a theoretical concern that the inflated cuffs on these devices may cause compression of the arteries in the neck that supply the brain. A recent study by Segal et al. 2 found a decrease in cerebral blood flow when EADs were used in a swine model. Colbert et al. 3 demonstrated that the laryngeal mask airway (LMA) cuff had an effect on the carotid bulb cross-sectional area and blood flow. Nandwani et al. 4 noted no sonographically evident displacement or compression of the internal jugular vein and the carotid artery in human subjects when an LMA was placed. In this study, we took advantage of a common practice at our institution in which well-functioning EADs placed in the field are left in situ for initial resuscitation and imaging in the ED. As a result, we have a number of patients who have undergone cross-sectional computed tomography (CT) studies of the cervical spine with various EADs in place. We examined whether or not mechanical carotid artery compression presumed to be secondary to the presence of the air-filled cuff in the hypopharynx was present in patients who underwent neck imaging studies and had EADs in place. We hypothesized that carotid artery compression would not be identified. METHODS Study DesignThis was a retrospective study of images acquired during usual care in our ED. This study received an exemption from our institutional review board.

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Section: Discussionmentioning

confidence: 99%

Radiographic Evaluation of Carotid Artery Compression in Patients With Extraglottic Airway Devices in Place

White¹,

Braude²,

Lorenzo

et al. 2015

Academic Emergency Medicine

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“…Using the Brain Trauma Foundation classification, we regarded 14 included studies 7 28 -31 33 34 36 -39 41 -43 as class 3 evidence and three studies as class 2 evidence (Table 1). 32 35 40 There was no class 1 evidence. In six studies, 33 36 38 39 41 42 the two reviewers' judgement on evidence classes differed and the final classification was made by consulting a third reviewer.…”

Section: Included Studiesmentioning

confidence: 99%

“…In two studies, the number of children included was unclear; 36 41 in one, age was not specified. 31 Assessment of study quality Study design and classification of evidence There were 12 retrospective analyses of trauma databases, registries, or hospital files, 7 28 -31 33 34 37 -39 41 42 three cohort studies, 36 40 43 one case -control study, 35 and one controlled trial with treatment allocation by alternating date 32 (Table 1). Of the database studies, eight 28 40 43 and the case -control study 35 had a historical control group.…”

Section: Included Studiesmentioning

confidence: 99%

“…7 Pre-hospital intubation and mechanical ventilation In four articles, 32 35 36 40 pre-hospital intubation and ventilation protocols were described in detail. In two studies, paramedics received specific training within the study's framework for 6 32 and 8 h, 35 respectively. RSI was performed in all field-intubated patients in four studies 30 35 36 40 and partly in three studies.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…5). Three studies 7 30 36 reported on pneumonia after pre-hospital or in-hospital intubation; it was the primary study outcome in In-hospital mortality Suominen and colleagues 29 Sloane and colleagues 30 Winchell and colleagues 31 Gausche and colleagues 32 Murray and colleagues 33 Cooper and colleagues 34 Davis and colleagues 35 Bochicchio and colleagues 36 DiRusso and colleagues 37 Wang and colleagues 38 Davis and colleagues 39 Davis and colleagues 28 Klemen and Grmec 40 1 h mortality von Elm et al …”

Section: Harm Outcomesmentioning

confidence: 99%

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Pre-hospital tracheal intubation in patients with traumatic brain injury: systematic review of current evidence

Elm

Schoettker

Henzi

et al. 2009

British Journal of Anaesthesia

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Association of Prehospital Advanced Airway Management With Neurologic Outcome and Survival in Patients With Out-of-Hospital Cardiac Arrest

Hasegawa¹,

Hiraide²,

Chang³

et al. 2013

JAMA

311

161

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Effect of Out-of-Hospital Pediatric Endotracheal Intubation on Survival and Neurological Outcome: A Controlled Clinical Trial

Cited by 168 publications

References 0 publications

Radiographic Evaluation of Carotid Artery Compression in Patients With Extraglottic Airway Devices in Place

Radiographic Evaluation of Carotid Artery Compression in Patients With Extraglottic Airway Devices in Place

Pre-hospital tracheal intubation in patients with traumatic brain injury: systematic review of current evidence

Association of Prehospital Advanced Airway Management With Neurologic Outcome and Survival in Patients With Out-of-Hospital Cardiac Arrest

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