Risk factors for unsuccessful prehospital laryngeal tube placement

Martin‐Gill, Christian; Prunty, Heather A.; Ritter, Seth C.; Carlson, Jestin N.; Guyette, Francis X.

doi:10.1016/j.resuscitation.2014.10.015

Cited by 17 publications

(8 citation statements)

References 27 publications

(42 reference statements)

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“…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%

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

Fiala

Lederer

Neumayr

et al. 2017

Scand J Trauma Resusc Emerg Med

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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.

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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

Scand J Trauma Resusc Emerg Med

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“…577 In five observational studies, a disposable version of the laryngeal tube (LT-D) was inserted successfully by prehospital personnel in 85-100% of OHCAs (number of cases ranged from 92 to 347). [578][579][580][581][582] Although some studies are supportive of the use of the LT during cardiac arrest several other studies have reported that insertion problems are common; these include problems with positioning and leakage. 580,583…”

Section: Laryngeal Tubementioning

confidence: 99%

European Resuscitation Council Guidelines for Resuscitation 2015

et al. 2015

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These Guidelines are based on the International Liaison Committee on Resuscitation (ILCOR) 2015 Consensus on Science and Treatment Recommendations (CoSTR) for ALS. 4 The 2015 ILCOR review focused on 42 topics organised in the approximate sequence of ALS interventions: defibrillation, airway, oxygenation and ventilation, circulatory support, monitoring during CPR, and drugs during CPR. For these Guidelines the ILCOR recommendations were supplemented by focused literature reviews undertaken by the ERC ALS Writing Group for those topics not reviewed in the 2015 ILCOR CoSTR. Guidelines were drafted and agreed by the ALS Writing Group members before final approval by the ERC General Assembly and ERC Board. Summary of changes since 2010 GuidelinesThe 2015 ERC ALS Guidelines have a change in emphasis aimed at improved care and implementation of these guidelines in order to improve patient focused outcomes. 5 The 2015 ERC ALS Guidelines do not include any major changes in core ALS interventions since the previous ERC guidelines published in 2010. 1,2 The key changes since 2010 are:• Continuing emphasis on the use of rapid response systems for care of the deteriorating patient and prevention of in-hospital cardiac arrest. • Continued emphasis on minimally interrupted high-quality chest compressions throughout any ALS intervention: chest

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“…Similarly, SGAs have successfully been used in the prehospital setting as first-line interventions in select populations4,5 and in cases of unanticipated difficult airways 14. While our work identifies variables predictive of difficult ETI, previous work has found that similar variables such as presence of a gag reflex are also associated with unsuccessful SGA placement 16. In combination with our tool, providers may consider this and elect to defer advanced airway maneuvers (ETI or SGA) in the prehospital setting if in proximity to the hospital.…”

Section: Discussionmentioning

confidence: 74%

“…Based on previous work evaluating difficult airways, the data elements in the form included patient demographics, patient characteristics, difficult airway characteristics, procedural characteristics, and techniques used to successfully intubate the patient (Table 1). 9,10,12,16 Upon completion of the custom form, the form was automatically forwarded, without patient or agency identifiers, to the study investigators. We then entered data into a spreadsheet for data analysis (Microsoft Excel, Redmond, WA).…”

Section: Methodsmentioning

confidence: 99%

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Derivation and Validation of The Prehospital Difficult Airway IdentificationTool (PreDAIT): A Predictive Model for Difficult Intubation

Carlson¹,

Hostler²,

Guyette³

et al. 2017

WestJEM

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IntroductionEndotracheal intubation (ETI) in the prehospital setting poses unique challenges where multiple ETI attempts are associated with adverse patient outcomes. Early identification of difficult ETI cases will allow providers to tailor airway-management efforts to minimize complications associated with ETI. We sought to derive and validate a prehospital difficult airway identification tool based on predictors of difficult ETI in other settings.MethodsWe prospectively collected patient and airway data on all airway attempts from 16 Advanced Life Support (ALS) ground emergency medical services (EMS) agencies from January 2011 to October 2014. Cases that required more than two ETI attempts and cases where an alternative airway strategy (e.g. supraglottic airway) was employed after one unsuccessful ETI attempt were categorized as “difficult.” We used a random allocation sequence to split the data into derivation and validation subsets. Using backward elimination, factors with a p<0.1 were included in the multivariable regression for the derivation cohort and then tested in the validation cohort. We used this model to determine the area under the curve (AUC), and the sensitivity and specificity for each cut point in both the derivation and validation cohorts.ResultsWe collected data on 1,102 cases with 568 in the derivation set (155 difficult cases; 27%) and 534 in the validation set (135 difficult cases; 25%). Of the collected variables, five factors were predictive of difficult ETI in the derivation model (adjusted odds ratio, 95% confidence interval [CI]): Glasgow coma score [GCS] >3 (2.15, 1.19–3.88), limited neck movement (2.24, 1.28–3.93), trismus/jaw clenched (2.24, 1.09–4.6), inability to palpate the landmarks of the neck (5.92, 2.77–12.66), and fluid in the airway such as blood or emesis (2.25, 1.51–3.36). This was the most parsimonious model and exhibited good fit (Hosmer-Lemeshow test p = 0.167) with an AUC of 0.68 (95% CI [0.64–0.73]). When applied to the validation set, the model had an AUC of 0.63 (0.58–0.68) with high specificity for identifying difficult ETI if ≥2 factors were present (87.7% (95% CI [84.1–90.8])).ConclusionWe have developed a simple tool using five factors that may aid prehospital providers in the identification of difficult ETI.

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Risk factors for unsuccessful prehospital laryngeal tube placement

Cited by 17 publications

References 27 publications

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

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

European Resuscitation Council Guidelines for Resuscitation 2015

Derivation and Validation of The Prehospital Difficult Airway IdentificationTool (PreDAIT): A Predictive Model for Difficult Intubation

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