Präklinische Anwendung des Larynxtubus

IntroductionSupraglottic airway devices have frequently been shown to facilitate airway management and are implemented in the ILCOR resuscitation algorithm. Limited data exists concerning laypersons without any medical or paramedical background. We hypothesized that even laymen would be able to operate supraglottic airway devices after a brief training session.MethodsFour different supraglottic airway devices: Laryngeal Mask Classic (LMA), Laryngeal Tube (LT), Intubating Laryngeal Mask (FT) and CobraPLA (Cobra) were tested in 141 volunteers recruited in a technical university cafeteria and in a shopping mall. All volunteers received a brief standardized training session. Primary endpoint was the time required to definitive insertion. In a short questionnaire applicants were asked to assess the devices and to answer some general questions about BLS.ResultsThe longest time to insertion was observed for Cobra (31.9 ± 27.9 s, range: 9-120, p < 0.0001; all means ± standard deviation). There was no significant difference between the insertion times of the other three devices. Fewest insertion attempts were needed for the FT (1.07 ± 0.26), followed by the LMA (1.23 ± 0.52, p > 0.05), the LT (1.36 ± 0.61, p < 0.05) and the Cobra (1.45 ± 0.7, p < 0.0001). Ventilation was achieved on the first attempt significantly more often with the FT (p < 0.001) compared to the other devices. Nearly 90% of the participants were in favor of implementing supraglottic airway devices in first aid algorithms and classes.ConclusionLaypersons are able to operate supraglottic airway devices in manikin with minimal instruction. Ventilation was achieved with all devices tested after a reasonable time and with a high success rate of > 95%. The use of supraglottic airway devices in first aid and BLS algorithms should be considered.

Section: Discussionmentioning

confidence: 65%

Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin

Schälte

Stoppe

Aktaş

et al. 2011

“…We encountered only one airway bleeding (blood stain on the device) and no case of aspiration in the LT group. However, factors associated with unsuccessful LT ventilation in the prehospital setting are numerous including incorrect placement of the tube in the trachea or in the pharynx, mucosa swelling of the tongue and throat and unrecognized airway obstruction [ 7 , 16 , 17 ]. Incorrect LT placement may cause gastric inflation, regurgitation and massive pulmonary aspiration.…”

Section: Discussionmentioning

confidence: 99%

“…Incorrect LT placement may cause gastric inflation, regurgitation and massive pulmonary aspiration. Dengler et al recommended that LTS should be used in all cases of emergency airway management [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial

Fiala

Lederer

Neumayr

et al. 2017

BackgroundLaryngeal tube (LT) application by rescue personnel as an alternate airway during the early stages of out-of-hospital cardiac arrest (OHCA) is still subject of debate. We evaluated ease of handling and efficacy of ventilation administered by emergency medical technicians (EMTs) using LT and bag-valve-mask (BVM) during cardiopulmonary resuscitation of patients with OHCA.MethodsAn open prospective randomized multicenter study was conducted at six emergency medical services centers over 18 months. Patients in OHCA initially resuscitated by EMTs were enrolled. Ease of handling (LT insertion, tight seal) and efficacy of ventilation (chest rises visibly, no air leak) with LT and BVM were subjectively assessed by EMTs during pre-study training and by the attending emergency physician on the scene. Outcome and frequency of complications were compared.ResultsOf 97 eligible patients, 78 were enrolled. During pre-study training EMTs rated efficacy of ventilation with LT higher than with BVM (66.7% vs. 36.2%, p = 0.022), but efficacy of on-site ventilation did not differ between the two groups (71.4% vs. 58.5%, p = 0.686). Frequency of complications (11.4% vs. 19.5%, p = 0.961) did not differ between the two groups.ConclusionsEMTs preferred LT ventilation to BVM ventilation during pre-study training, but on-site there was no difference with regard to efficacy, ventilation safety, or outcome. The results indicate that LT ventilation by EMTs during OHCA is not superior to BVM and cannot substitute for BVM training. We assume that the main benefit of the LT is the provision of an alternative airway when BVM ventilation fails. Training in BVM ventilation remains paramount in EMT apprenticeship and cannot be substituted by LT ventilation.Trial registration ClinicalTrials.gov (NCT01718795).Electronic supplementary materialThe online version of this article (10.1186/s13049-017-0446-1) contains supplementary material, which is available to authorized users.

“…Gastric distension can potentially develop into a serious life-threatening condition. There are some case reports of this problem with supraglottic airway devices, especially in emergency medicine [ 28 , 29 ]. The iLTS-D features the opportunity of a gastric tube similarly to the LTS-D. A comparison of the LTS-D to the ProSeal laryngeal mask found no difference in the facilitation of gastric tube placement (successful gastric tube insertion: ProSeal: 97 %, LTS-D: 96 %) [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

The novel intubating laryngeal tube (iLTS-D) is comparable to the intubating laryngeal mask (Fastrach) – a prospective randomised manikin study

Ott

Fischer

Limbach

et al. 2015

BackgroundSupraglottic devices are helpful for inexperienced providers who perform ventilation in emergency situations. Most supraglottic devices do not allow secondary tracheal intubation through the device. The novel intubating laryngeal tube (iLTS-D®) and the intubating laryngeal mask (Fastrach™) are devices that offer supraglottic ventilation and secondary tracheal intubation.MethodsWe evaluated the novel iLTS-D and compared it to the established Fastrach using a manikin-based study. Participants used both devices in a randomised order. The participants conducted four consecutive trials on a manikin. One trial was composed of the following procedures. First, participants ventilated the manikin using either iLTS-D or Fastrach. ‘Time to ventilation’, success rates and number of attempts were recorded for the supraglottic device. Second, participants intubated the manikin through the previously inserted supraglottic device. ‘Time to tracheal ventilation’, success rate and tube localisation were recorded. The primary endpoint was the results of the final fourth trial, which mirrored the standardised training of trials 1, 2 and 3.ResultsA total of 64 participants were enrolled. All of the participants successfully inserted both devices on their first attempt in trial 4. Fastrach was applied 1 s faster in trial 4 than the iLTS-D (median ‘time to ventilation’ Fastrach: 13.5 s., iLTS-D: 14.5 s., p = 0.04). All participants successfully intubated through both devices in trial 4. There was no difference in ‘time to tracheal ventilation’ by tracheal intubation between either device (median ‘time to tracheal ventilation’: Fastrach: 14.0 s., iLTS-D: 14.0 s., p = 0.16).ConclusionThe iLTS-D performed similarly to the ILMA in insertion and intubation times in a manikin setting.