New airways for resuscitation?

Cook, Tim; Hommers, Clare

doi:10.1016/j.resuscitation.2005.10.015

Cited by 72 publications

(41 citation statements)

References 80 publications

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“…The LT was intended as both a primary and secondary airway device for emergency situations, and its variants LT-D and LTSonda II with a suction channel have been used prehospitally. The LMA and its variants have become a very popular airway management device for anaesthesia [see (20) and references therein].…”

Section: Supraglottic Airway Devices (Sads)mentioning

confidence: 99%

Pre‐hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine

Berlac

Hyldmo

Kongstad³

et al. 2008

Acta Anaesthesiol Scand

111

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This article is intended as a generic guide to evidencebased airway management for all categories of pre-hospital personnel. It is based on a review of relevant literature but the majority of the studies have not been performed under realistic, pre-hospital conditions and the recommendations are therefore based on a low level of evidence (D). The advice given depends on the qualifications of the personnel available in a given emergency medical service (EMS). Anaesthetic training and routine in anaesthesia and neuromuscular blockade is necessary for the use of most techniques in the treatment of patients with airway reflexes. For anaesthesiologists, the Task Force commissioned by the Scandinavian Society of Anaesthesia and Intensive Care Medicine recommends endotracheal intubation (ETI) following rapid sequence induction when securing the pre-hospital airway, although repeated unsuccessful intubation attempts should be avoided independent of formal qualifications. Other physicians, as well as paramedics and other EMS personnel, are recommended the lateral trauma recovery position as a basic intervention combined with assisted mask-ventilation in trauma patients. When performing advanced cardiopulmonary resuscitation, we recommend that non-anaesthesiologists primarily use a supraglottic airway device. A supraglottic device such as the laryngeal tube or the intubation laryngeal mask should also be available as a backup device for anaesthesiologists in failed ETI. Accepted for publication 25 February 2008Key words: Pre-hospital; airway management; endotracheal intubation; laryngeal mask airway; laryngeal tube airway; combitube; emergency medical systems. Purpose T HIS article is intended as a guide to evidencebased pre-hospital airway management. The available litterature on pre-hospital airway management reflects vast differences in pre-hospital emergency medicine service (EMS) organisation, qualification levels, training programmes and even terminology. These differences make comparisons between systems and treatment protocols difficult at best. The conduct of clinical trials in pre-hospital airway management is hampered by the 2001/20/ EC directive of the European Parliament concerning informed consent. This paper describes selected equipment and techniques available for pre-hospital airway management. Advice given differs, depending on which category of personnel is available in a given EMS. Our baseline assumption is that a certain level of education and training is necessary for the safe use of a specific technique. Distinction must be made between personnel trained and experienced in providing and monitoring anaesthesia and other groups of personnel with limited or no anaesthetic skills. This distinction dictates which drugs and equipment that should be available in the prehospital setting. Differences between regions and systemsParamedic-based systems are the rule in the United States, whereas physician-based pre-hospital systems are common in Europe. Ideally, the best person to manage the pre-hospital airwa...

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Section: Supraglottic Airway Devices (Sads)mentioning

confidence: 99%

Pre‐hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine

Berlac

Hyldmo

Kongstad³

et al. 2008

Acta Anaesthesiol Scand

111

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“…Despite there being numerous supraglottic airways [12], to date, only the LMA [7,9], the intubating LMA TM (LMA Company, Jersey, Channel Isles, UK) [13] and the cuffed oropharyngeal airway (COPA; Mallinckrodt Medical, Athlone, Ireland) [14] have been evaluated for use whilst wearing CBRN-PPE. Recently, however, Barns et al [15] evaluated the Laryngeal Tube TM (VBM Medizintechnik GmbH, Sulz, Germany) for use whilst wearing fire rescue equipment, but not specifically CBRN-PPE.…”

mentioning

confidence: 99%

Insertion of six different supraglottic airway devices whilst wearing chemical, biological, radiation, nuclear‐personal protective equipment: a manikin study

2011

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Summary Six different supraglottic airway devices: Combitube™, laryngeal mask airway, intubating laryngeal mask airway (Fastrach™), i‐gel™, Laryngeal Tube™ and Pro‐Seal™ laryngeal mask airway were assessed by 58 paramedic students for speed and ease of insertion in a manikin, whilst wearing either chemical, biological, radiation, nuclear‐personal protective equipment (CBRN‐PPE) or a standard uniform. All devices took significantly longer to insert when wearing CBRN‐PPE compared with standard uniform (p < 0.001). In standard uniform, insertion time was shorter than 45 s in 90% of attempts for all devices except the Combitube, for which 90% of attempts were completed by 53 s. Whilst wearing CBRN‐PPE the i‐gel was the fastest device to insert with a mean (SD (95% CI)) insertion time of 19 (8 (17–21))s, p < 0.001, with the Combitube the slowest with mean (65 (23 (59–71))s. Wearing of CBRN‐PPE has a negative impact on supraglottic airway insertion time. You can respond to this article at http://www.anaesthesiacorrespondence.com

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“…68 Its ease of insertion may be one of the reasons for its wider acceptance into resuscitation guidelines. [69][70][71][72][73] Another major consideration during prehospital airway management is cervical spine movement during placement of the SAD or ETT. The LMA (median 2.5°) and the combitube (median 1.5°; Nellcor Puritan Bennett, Pleasanton, California) caused less extension of the upper cervical vertebrae (C0-C1) compared with the McCoy laryngoscope (median 7°).…”

Section: Resuscitation and Prehospital Airway Managementmentioning

confidence: 99%

Supraglottic Airway DevicesDiscussion

Ramachandran

Kumar

2014

Respir Care

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SummarySupraglottic airway devices (SADs) are used to keep the upper airway open to provide unobstructed ventilation. Early (first-generation) SADs rapidly replaced endotracheal intubation and face masks in > 40% of general anesthesia cases due to their versatility and ease of use. Second-generation devices have further improved efficacy and utility by incorporating design changes. Individual second-generation SADs have allowed more dependable positive-pressure ventilation, are made of disposable materials, have integrated bite blocks, are better able to act as conduits for tracheal tube placement, and have reduced risk of pulmonary aspiration of gastric contents. SADs now provide successful rescue ventilation in > 90% of patients in whom mask ventilation or tracheal intubation is found to be impossible. However, some concerns with these devices remain, including failing to adequately ventilate, causing airway damage, and increasing the likelihood of pulmonary aspiration of gastric contents. Careful patient selection and excellent technical skills are necessary for successful use of these devices.

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New airways for resuscitation?

Cited by 72 publications

References 80 publications

Pre‐hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine

Pre‐hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine

Insertion of six different supraglottic airway devices whilst wearing chemical, biological, radiation, nuclear‐personal protective equipment: a manikin study

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