The Process of Prehospital Airway Management

Prekker, Matthew E.; Kwok, Heemun; Shin, Jenny; Carlbom, David; Grabinsky, Andreas; Rea, Thomas D.

doi:10.1097/ccm.0000000000000213

Cited by 72 publications

(23 citation statements)

References 36 publications

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“…Traditional training in airway management relies on use of airway mannequins and intubations in the controlled setting of the operating room in fasting, preoxygenated patients 1,2. Neither of these methods duplicates the dynamic, challenging conditions surrounding emergency airways, including actively vomiting patients and those with blood and secretions contaminating the glottic view 3. Blood and vomitus in the airway has been identified as a predictor of difficult intubation 4,5,6,7.…”

Section: Introductionmentioning

confidence: 99%

Novel Airway Training Tool that Simulates Vomiting: Suction-Assisted Laryngoscopy Assisted Decontamination (SALAD) System

DuCanto¹,

Serrano²,

Thompson³

2017

WestJEM

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IntroductionWe present a novel airway simulation tool that recreates the dynamic challenges associated with emergency airways. The Suction-Assisted Laryngoscopy Assisted Decontamination (SALAD) simulation system trains providers to use suction to manage emesis and bleeding complicating intubation.MethodsWe modified a standard difficult-airway mannequin head (Nasco, Ft. Atkinson, WI) with hardware-store equipment to enable simulation of vomiting or hemorrhage during intubation. A pre- and post-survey was used to assess the effectiveness of the SALAD simulator. We used a 1–5 Likert scale to assess confidence in managing the airway of a vomiting patient and comfort with suction techniques before and after the training exercise.ResultsForty learners participated in the simulation, including emergency physicians, anesthesiologists, paramedics, respiratory therapists, and registered nurses. The average Likert score of confidence in managing the airway of a vomiting or hemorrhaging patient pre-session was 3.10±0.49, and post-session 4.13±0.22. The average score of self-perceived skill with suction techniques in the airway scenario pre-session was 3.30±0.43, and post-session 4.03±0.26. The average score for usefulness of the session was 4.68±0.15, and the score for realism of the simulator was 4.65±0.17.ConclusionA training session with the SALAD simulator improved trainee’s confidence in managing the airway of a vomiting or hemorrhaging patient. The SALAD simulation system recreates the dynamic challenges associated with emergency airways and holds promise as an airway training tool.

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Section: Introductionmentioning

confidence: 99%

Novel Airway Training Tool that Simulates Vomiting: Suction-Assisted Laryngoscopy Assisted Decontamination (SALAD) System

DuCanto¹,

Serrano²,

Thompson³

2017

WestJEM

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“…Some out-of-hospital diseases, such as cardiac arrest, respiratory failure, traumatic injuries, may result in severe hypoxemia or hypotension 5 . Intubation should be administered immediately when indicated.…”

Section: Discussionmentioning

confidence: 99%

An original design of remote robot-assisted intubation system

Wang

Tao

et al. 2018

Sci Rep

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The success rate of pre-hospital endotracheal intubation (ETI) by paramedics is lower than physicians. We aimed to establish a remote robot-assisted intubation system (RRAIS) and expected it to improve success rate of pre-hospital ETI. To test the robot’s feasibility, 20 pigs were intubated by direct laryngoscope or the robot system. Intubation time, success rate, airway complications were recorded during the experiment. The animal experiment showed that participants achieved a higher success rate in absolute numbers by the robot system. In summary, we have successfully developed a remote robot-assisted intubation system. It is promising for RRAIS to improve the success rate of pre-hospital ETI and change the current rescue model.

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“…Meanwhile, Diggs [ 28 ] reported an overall ETI success rate in cardiac arrest patients of 85.5 %. Yet, even if success rates are acceptable, EMS personnel are nevertheless liable to encounter significant challenges [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Airway management in out-of-hospital cardiac arrest in Finland: current practices and outcomes

Hiltunen

Jäntti

Silfvast

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundThough airway management methods during out-of-hospital cardiac arrest (OHCA) remain controversial, no studies on the topic from Finland have examined adherence to OHCA recommendations in real life. In response, the aim of this study was to document the interventions, success rates, and adverse events in airway management processes in OHCA, as well as to analyse survival at hospital discharge and at follow-up a year later.MethodsDuring a 6-month study period in 2010, data regarding all patients with OHCA and attempted resuscitation in southern and eastern Finland were prospectively collected. Emergency medical services (EMS) documented the airway techniques used and all adverse events related to the process. Study endpoints included the frequency of different techniques used, their success rates, methods used to verify the correct placement of the endotracheal tube, overall adverse events, and survival at hospital discharge and at follow-up a year later.ResultsA total of 614 patients were included in the study. The incidence of EMS-attempted resuscitation was determined to be 51/100,000 inhabitants per year. The final airway technique was endotracheal intubation (ETI) in 413 patients (67.3 %) and supraglottic airway device (SAD) in 188 patients (30.2 %). The overall success rate of ETI was 92.5 %, whereas that of SAD was 85.0 %. Adverse events were reported in 167 of the patients (27.2 %). Having a prehospital EMS physician on the scene (p < .001, OR 5.05, 95 % CI 2.94–8.68), having a primary shockable rhythm (p < .001, OR 5.23, 95 % CI 3.05–8.98), and being male (p = .049, OR 1.80, 95 % CI 1.00–3.22) were predictors for survival at hospital discharge.ConclusionsThis study showed acceptable ETI and SAD success rates among Finnish patients with OHCA. Adverse events related to airway management were observed in more than 25 % of patients, and overall survival was 17.8 % at hospital discharge and 14.0 % after 1 year.

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The Process of Prehospital Airway Management

Cited by 72 publications

References 36 publications

Novel Airway Training Tool that Simulates Vomiting: Suction-Assisted Laryngoscopy Assisted Decontamination (SALAD) System

Novel Airway Training Tool that Simulates Vomiting: Suction-Assisted Laryngoscopy Assisted Decontamination (SALAD) System

An original design of remote robot-assisted intubation system

Airway management in out-of-hospital cardiac arrest in Finland: current practices and outcomes

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