INVESTIGATION OF UPPER AIRWAY PROBLEMS IN RESUSCITATION 1. Studies of Pharyngeal X-rays and Performance by Laymen

Part 5: Adult Basic Life Support

“…Evidence from a case series of drowning victims (LOE 4 139 ) and 6 prospective clinical studies in patients under anesthesia that evaluated clinical (LOE 5 140 -142 ) or radiological (LOE 5 [143][144][145] ) measures of airway patency indicates that the head tilt-chin lift maneuver is feasible, safe, and effective. Two prospective clinical studies evaluating clinical (LOE 5 146 ) or radiological (LOE 5 147 ) measures supported the chin lift maneuver in children under anesthesia, while 3 other prospective clinical studies failed to prove the effect compared to neutral position (LOE 5 148 -150 ).…”

“…In a few case reports, a finger sweep was effective for relieving FBAO in unconscious adults and children aged Ͼ1 year (LOE 4 161,162,170 ). Case reports documented harm to the victims or biting of the rescuer's finger with finger sweeps (LOE 4 145,171 and LOE 5 155,156,173 ).…”

Does Active Rescuer Ventilation Have a Place During Basic Cardiopulmonary Resuscitation?

“…24 He argued that in the absence of an endotracheal tube supine, unconscious humans with the head in neutral position have an obstructed airway, contrary to pigs and dogs, 25 and when using a spirometer accurate for tidal volumes Ͼ20 mL, he found no detectable tidal volume in 30 subjects secondary to chest compressions versus a mean of 156 mL with an artificial airway in place. 26 In a recent study of 17 cardiac arrest victims with endotracheal tubes in place, Deakin et al 27 reported median tidal volumes of only 41.5 mL secondary to 1.5-to 2-in mechanical chest compressions, one-fourth the patients' median dead space.…”

Unerwartet erwartbar schwieriger Atemweg

“…Anatomisch-funktionell entspricht dem im Kopf-Hals-Bereich eine verminderte Beweglichkeit laryngealer und pharyngealer Strukturen; klinisch finden sich bei nicht wenigen Patienten Schluckstörun-gen [10]. Innerhalb der ersten 4 bis 5 Jahre ist mit einer stetigen Zunahme der Fibrosierung zu rechnen [2] [9,17,18]. Dieser Effekt sollte im berichteten Fall durch einen ventral gerichteten Zug mit dem GlideScope ausgeglichen werden; dies gelang jedoch bei der Patientin nicht.…”