Andrzej Bielski1, Marcin Madziala1, 2, Karol Bielski3, 4, Jacek Smereka5, Klaudiusz Nadolny6, *Lukasz Szarpak2, 3
Blind intubation via iGEL laryngeal mask performed by novice physicians: A randomized, crossover, manikin trial
Intubacja na ślepo z zastosowaniem maski krtaniowej iGEL wykonywana przez lekarzy stażystów: randomizowane, krzyżowe badanie symulacyjne
1Polish Society of Disaster Medicine, Warsaw, Poland
2Lazarski University, Warsaw, Poland
3MEDITRANS The Voivodship Emergency Medical Service and Sanitary Transport, Warsaw, Poland
4Department of Administrative Law, Lazarski University, Warsaw, Poland
5Department of Emergency Medical Service, Wroclaw Medical University, Poland
6Department of Emergency Medicine, Medical University of Bialystok, Poland
Streszczenie
Wstęp. Wykonanie intubacji dotchawiczej w oparciu o laryngoskopię bezpośrednią jest procedurą wymagającą dużego doświadczenia od personelu medycznego. Alternatywą dla tej metody może być wykonywanie intubacji na ślepo z zastosowaniem nadgłośniowych urządzeń do wentylacji jako swoistej prowadnicy dla rurki intubacyjnej.
Cel pracy. Celem badania była ocena skuteczności intubacji na ślepo z zastosowaniem maski krtaniowej iGEL, wykonywanej przez lekarzy stażystów w warunkach symulowanej resuscytacji krążeniowo-oddechowej.
Materiał i metody. W badaniu zaprojektowanym jako prospektywne, randomizowane, krzyżowe badanie symulacyjne udział wzięło 42 lekarzy stażystów. Uczestnicy badania wykonywali intubację na ślepo, stosując maskę krtaniową iGEL jako prowadnicę dla rurki intubacyjnej. Intubacja odbywała się podczas symulowanej resuscytacji krążeniowo-oddechowej osoby dorosłej w dwóch scenariuszach: scenariusz A – bez uciskania klatki piersiowej, scenariusz B – ciągłe uciskanie klatki piersiowej. Protokół badania został zaakceptowany przez Radę Programową Polskiego Towarzystwa Medycyny Katastrof (zgoda: 32.03.2018.IRB). Uzyskano także pisemną zgodę od 42 uczestników.
Wyniki. Skuteczność pierwszej próby zabezpieczenia drożności dróg oddechowych za pomocą maski iGEL wynosiła 100% podczas obu scenariuszy badawczych. W przypadku intubacji na ślepo skuteczność ta wynosiła 80,9% dla scenariusza A oraz 73,8% dla scenariusza B (p = 0,056). Czas wykonania intubacji na ślepo wynosił w scenariuszu A – 29,5 s (IQR: 24-41), zaś w przypadku scenariusza B – 31 s (23-45,5; p = 0,318).
Wnioski. W przeprowadzonym badaniu symulacyjnym uczestnicy badania byli w stanie z wysoką skutecznością i w krótkim czasie wykonywać intubację dotchawiczą na ślepo z wykorzystaniem maski krtaniowej iGEL jako prowadnicy dla rurki intubacyjnej.
Summary
Introduction. Performing endotracheal intubation based on direct laryngoscopy is a procedure that requires extensive experience from medical personnel. An alternative to this method may be performing blind intubation using supraglottic ventilation devices as a specific guide for the endotracheal tube.
Aim. The aim of the study was to evaluate the efficacy of blind intubation using the iGEL laryngeal mask performed by trainee doctors in simulated cardiopulmonary resuscitation conditions.
Material and methods. In a study designed as a prospective, randomized, cross-study simulation, forty-two interns participated. The participants of the study performed blind intubation using the iGEL laryngeal mask as a guide for the endotracheal tube. Intubation was carried out during simulated CPR in an adult scenario: scenario A – without chest compressions; scenario B – continuous chest compressions. After approval from the Institutional Review Board of the Polish Society of Disaster Medicine (Approval no. 32.03.2018.IRB), written informed consent was obtained from 42 participants.
Results. The effectiveness of the first attempt to protect the airway patency with the iGEL mask was 100% during both research scenarios. In the case of blind intubation, the effectiveness was 80.9% for scenario A, and 73.8% for scenario B (p = 0.056). The duration of blind intubation was 29.5 s (IQR: 24-41), while scenario B took 31 s (23-45.5, p = 0.318).
Conclusions. In the conducted simulation experiment, the participants were able to perform endotracheal intubation blindly with the use of the iGEL as a guide for the endotracheal tube with high efficiency and in a short period of time.
INTRODUCTION
The ability to protect airway patency in both pre-hospital and hospital settings is one of the basic skills of medical personnel. In normothermic conditions, oxygen reserves are sufficient enough for only 3-5 minutes. After this time, irreversible changes associated with progressive hypoxia occur. The central nervous system is the most susceptible organ for hypoxia, therefore it is the first organ to become damaged. In relation to above, quick protection of airway patency and implementation of oxygen therapy is a key element in the management of the patient, especially regarding to a patient with cardiac arrest. According to the guidelines for cardiopulmonary resuscitation published by the European Resuscitation Council (1) as well as the American Heart Association (2), the gold standard for protecting the airways during resuscitation is endotracheal intubation. It allows you to perform asynchronous resuscitation in addition to achieving adequate final pressure in the airway. The guidelines mentioned above recommend that endotracheal intubation be performed during uninterrupted chest compressions or only with a short break in compressions to allow the insertion of the endotracheal tube between the vocal folds, which in turn minimizes breaks in chest compressions. However, as indicated by numerous studies, a more preferred method is the interruption of chest compressions at the time of intubation, due to the fact that continuous chest compressions reduce the effectiveness of the first endotracheal intubation attempt and extend the duration of the procedure (3-5).
Another important factor that may influence the effectiveness of intubation is the experience of the individual performing endotracheal intubation. The ERC and AHA guidelines recommend that it be performed by the most experienced person on the team. This is important due to the potential complications of intubation, such as damage to the teeth, damage to soft tissues and the induction of bleeding, epiglottis detachment, dislocation of the cartilage, or tearing of the trachea. In the case of inability to perform standard intubation guided by direct laryngoscopy, medical personnel may use various alternative methods such as supraglottic ventilation devices or video laryngoscopy. The use of video laryngoscopes, as indicated by numerous studies, increases the effectiveness of intubation, especially for patients with difficult airways, however, due to the price, they are rarely encountered in pre-hospital care.
AIM
The aim of the study was to assess the effectiveness of blind intubation via iGEL laryngeal mask by physicians during simulated cardiopulmonary scenarios.
MATERIAL AND METHODS
After approval from the Institutional Review Board of the Polish Society of Disaster Medicine (Approval no. 32.03.2018.IRB), written informed consent was obtained from 42 participants. All participants had limited clinical experience in endotracheal intubation. Before recruitment into our trial, all participants had never attempted airway management using supraglottic airway devices.
During the experiment, we used iGEL size 4 (Intersurgical, Wokingham, Berkshire, United Kingdom) and a standard intubation tube (7.0ID; Sumi, Sulejowek, Poland). In order to simulate the patient in cardiac arrest, Resusci Anne Simulator (Laerdal, Stavanger, Norway) was used, which has been designed to simulate the adult patient. In order to simulate cardiopulmonary resuscitation and the need to secure the airway in conditions of uninterrupted chest compressions, the chest compression device LUCAS3 (Physio-Control, Redmond, WA, USA) was used. Protection of airway patency occurred in two scenarios: scenario A – without chest compressions; scenario B – protection of airway patency during uninterrupted chest compressions (6, 7).
Prior to the study, all participants took part in theoretical training in the field of airway obstruction using supraglottic ventilation devices. Theoretical training was completed with a tutorial given by an experienced instructor. Practical exercises were not allowed.
Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Mam kod dostępu
- Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu albo wszystkich artykułów (w zależności od wybranej opcji), należy wprowadzić kod.
- Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.
- Aby kupić kod proszę skorzystać z jednej z poniższych opcji.
Opcja #1
24 zł
Wybieram
- dostęp do tego artykułu
- dostęp na 7 dni
uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony
Opcja #2
59 zł
Wybieram
- dostęp do tego i pozostałych ponad 7000 artykułów
- dostęp na 30 dni
- najpopularniejsza opcja
Opcja #3
119 zł
Wybieram
- dostęp do tego i pozostałych ponad 7000 artykułów
- dostęp na 90 dni
- oszczędzasz 28 zł
Piśmiennictwo
1. Soar J, Nolan JP, Böttiger BW et al.: Adult advanced life support section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2015; 95: 100-147.
2. Link MS, Berkow LC, Kudenchuk PJ et al.: Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132(18 suppl. 2): S444-464.
3. Aleksandrowicz S, Czyzewski L, Smereka J et al.: Tracheal intubation with a Macintosh laryngoscope with and without chest compressions, performed by nurses. Am J Emerg Med 2016; 34(12): 2448-2449.
4. Kurowski A, Szarpak L, Zasko P et al.: Comparison of direct intubation and Supraglottic Airway Laryngopharyngeal Tube (S.A.L.T.) for endotracheal intubation during cardiopulmonary resuscitation. Randomized manikin study. Anaesthesiol Intensive Ther 2015; 47(3): 195-199.
5. Madziala A, Evrin T, Wieczorek W et al.: Can the face-to-face intubation technique be used during cardiopulmonary resuscitation? A prospective, randomized, crossover mankin trial. Disaster Emerg Med J 2017; 2(4): 145-149.
6. Szarpak L, Czyzewski L, Kurowski A et al.: Comparison of the TruView PCD video laryngoscope and macintosh laryngoscope for pediatric tracheal intubation by novice paramedics: a randomized crossover simulation trial. Eur J Pediatr 2015; 174(10): 1325-1332.
7. Szarpak L, Truszewski Z, Czyzewski L et al.: A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics. A randomized, crossover, manikin study. Am J Emerg Med 2016; 34(8): 1338-1341.
8. Konski R, Cieciel M, Madziala M et al.: Impact of a CPRMeter feedback device on chest compression quality performer by nurses: A randomized crossover study. Am J Emerg Med 2018. pii: S0735-6757(18)30297-3.
9. Harris AW, Kudenchuk PJ: Cardiopulmonary resuscitation: the science behind the hands. Heart 2018. pii: heartjnl-2017-312696.
10. Smereka J, Kaminska H, Wieczorek W et al.: Which position should we take during newborn resuscitation? A prospective, randomized, multicentre simulation trial. Kardiol Pol 2018 Jan 19. DOI: 10.5603/KP.a2018.0030.
11. Bhardwaj A, Abella BS: Does chest compression fraction matter, after all? Resuscitation 2015; 97: A5-6.
12. Perkins GD, Olasveengen TM, Maconochie I et al.; European Resuscitation Council: European Resuscitation Council Guidelines for Resuscitation: 2017 update. Resuscitation 2018; 123: 43-50.
13. Brown CA 3rd, Bair AE, Pallin DJ et al.; NEAR III Investigators: Techniques, success, and adverse events of emergency department adult intubations. Ann Emerg Med 2015; 65(4): 363-370.e1.
14. Pallin DJ, Dwyer RC, Walls RM et al.; NEAR III Investigators: Techniques and Trends, Success Rates, and Adverse Events in Emergency Department Pediatric Intubations: A Report From the National Emergency Airway Registry. Ann Emerg Med 2016; 67(5): 610-615.e1.
15. Corso RM, Piraccini E, Agnoletti V et al.: Use of an i-gel in a “can’t intubate/can’t ventilate” situation. Anaesth Intensive Care 2010; 38(1): 212.
16. Pandit JJ, Irwin MG: Airway management in critical illness: practice implications of new Difficult Airway Society guidelines. Anaesthesia 2018; 73(5): 544-548.
17. Higgs A, McGrath BA, Goddard C et al.; Difficult Airway Society; Intensive Care Society; Faculty of Intensive Care Medicine; Royal College of Anaesthetists: Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth 2018; 120(2): 323-352.
18. Ehrlich PF, Seidman PS, Atallah O et al.: Endotracheal intubations in rural pediatric trauma patients. J Pediatr Surg 2004; 39(9): 1376-1380.
19. Sagarin MJ, Barton ED, Chng YM et al.; National Emergency Airway Registry Investigators: Airway management by US and Canadian emergency medicine residents: a multicenter analysis of more than 6,000 endotracheal intubation attempts. Ann Emerg Med 2005; 46(4): 328-336.
20. Szarpak L, Czyzewski L, Truszewski Z et al.: of Coopdech®, CoPilot®, Intubrite®, and Macintosh laryngoscopes for tracheal intubation during pediatric cardiopulmonary resuscitation: a randomized, controlled crossover simulation trial. Eur J Pediatr 2015; 174(11): 1517-1523.
21. Aleksandrowicz D, Gaszynski T: Intubation through 2 supraglottic airway device in cervical spine immobilization: a randomized trial of residents’ use of the intubating laryngeal mask airway and the intubating laryngeal tube in manikins. Emergencias 2018; 30(3): 186-189.
22. Kim JG, Kim W, Kang GH et al.: Pre-hospital i-gel blind intubation for trauma: a simulation study. Clin Exp Emerg Med 2018; 5(1): 29-34.
23. Adams AS, Wannemuehler TJ, Hull B et al.: Randomized controlled trial comparing the supraglottic airway to use of an endotracheal tube in sinonasal surgery. Int Forum Allergy Rhinol 2018 May 2. DOI: 10.1002/alr.22132.
24. Malhotra SK, Bharath KV, Saini V: Comparison of success rate of intubation through Air-Q with ILMA using two different endotracheal tubes. Indian J Anaesth 2016; 60(4): 242-247.
25. Yamada R, Maruyama K, Hirabayashi G et al.: Effect of head position on the success rate of blind intubation using intubating supraglottic airway devices. Am J Emerg Med 2016; 34(7): 1193-1197.
26. Szarpak L, Truszewski Z, Vitale J et al.: Exchange of supraglottic airways for endotracheal tube using the Eschmann Introducer during simulated child resuscitation: A randomized study comparing 4 devices. Medicine (Baltimore) 2017; 96(26): e7177:1-6.
27. Szarpak L, Karczewska K, Czyzewski L et al.: A randomized comparison of the Laryngoscope with Fiber Optic Reusable Flexible Tip English Macintosh blade to the conventional Macintosh laryngoscope for intubation in simulated easy and difficult child airway with chest compression scenarios. Am J Emerg Med 2015; 33(7): 951-956.
