Skip to main content
SpringerLink
Log in

Supraglottische Atemwegshilfen in der Notfallmedizin

Stellenwert der Magendrainage

Supraglottic airway devices in emergency medicine

Impact of gastric drainage

  • Kasuistiken
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Der vorliegende Fallbericht schildert den lebensrettenden präklinischen Einsatz eines LT-D™-Larynxtubus (Fa. VBM Medizintechnik, Sulz) bei einem schwer verletzten Traumapatienten nach Treppensturz. Als Komplikation kam es unter mechanischer Beatmung zu wiederholten Atemwegsobstruktionen und einer stark ausgeprägten Magendistension durch Leckageluft, die noch in der Schockraumphase die Ventilierbarkeit des Patienten derart einschränkten, dass eine notfallmäßige endotracheale Intubation durchgeführt werden musste. Es werden die Ursachen der aufgetretenen Magendistension und die drastischen unmittelbaren Folgen für die Ventilierbarkeit des Patienten erörtert. Potenziell deletäre nichtpulmonale Folgen einer Magendistension werden diskutiert, und es erfolgt eine Standortbestimmung supraglottischer Atemwegshilfen im Rettungsdienst. Die klinische Relevanz der beschriebenen Komplikationen führt zwingend zu der Empfehlung, in der präklinischen Notfallmedizin ausschließlich supraglottische Atemwegshilfen der 2. Generation mit integriertem Magendrainagekanal einzusetzen.

Abstract

This case report describes a life-saving use of a supraglottic airway device (LT-D™-Larynxtubus, VBM Medizintechnik, Sulz, Germany) in an out-of-hospital emergency patient suffering from severe traumatic brain injury. Mechanical ventilation with the laryngeal tube was complicated by repeated airway obstructions and pronounced gastric distension with air as a consequence of oropharyngeal leakage. In this situation pulmonary ventilation of the patient was compromised so that emergency endotracheal intubation became necessary in the resuscitation area with vital indications. In this context the status of supraglottic airway devices in emergency medicine is discussed as well as the reasons for the gastric distension. Besides the immediate drastic consequences of gastric distension with respect to pulmonary ventilation, potential deleterious non-pulmonary consequences of this complication are highlighted. The clinical relevance of the described complications as well as the associated possibility of an optimized position control necessitate the recommendation only to use second generation supraglottic airway devices with integrated gastric access in (out-of-hospital) emergency medicine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Adnet F, Jouriles NJ, Le Toumelin P et al (1998) Survey of out-of-hospital emergency intubations in the French prehospital medical system: a multicenter study. Ann Emerg Med 32:454–460

    Article  PubMed  CAS  Google Scholar 

  2. Asai T, Hidaka I, Kawachi S (2002) Efficacy of the laryngeal tube by inexperienced personnel. Resuscitation 55:171–175

    Article  PubMed  Google Scholar 

  3. Bercker S, Schmidbauer W, Volk T et al (2008) A comparison of seal in seven supraglottic airway devices using a cadaver model of elevated esophageal pressure. Anesth Analg 106:445–448

    Article  PubMed  Google Scholar 

  4. Berlac P, Hyldmo PK, Kongstad P et al (2008) Pre-hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand 52:897–907

    Article  PubMed  CAS  Google Scholar 

  5. Brain AI (1983) The laryngeal mask – a new concept in airway management. Br J Anaesth 55:801–805

    Article  PubMed  CAS  Google Scholar 

  6. Braun P, Wenzel V, Paal P (2010) Anesthesia in prehospital emergencies and in the emergency department. Curr Opin Anaesthesiol 23:500–506

    Article  PubMed  Google Scholar 

  7. Breckwoldt J, Klemstein S, Brunne B et al (2011) Difficult prehospital endotracheal intubation – predisposing factors in a physician based EMS. Resuscitation 82:1519–1524

    Article  PubMed  Google Scholar 

  8. Brimacombe J, Keller C (2003) Aspiration of gastric contents during use of a ProSeal laryngeal mask airway secondary to unidentified foldover malposition. Anesth Analg 97:1192–1194

    Article  PubMed  Google Scholar 

  9. Cobas MA, De la Pena MA, Manning R et al (2009) Prehospital intubations and mortality: a level 1 trauma center perspective. Anesth Analg 109:489–493

    Article  PubMed  Google Scholar 

  10. Cook T, Howes B (2011) Supraglottic airway devices: recent advances. Contin Educ Anaesth Crit Care Pain 2:56–61

    Article  Google Scholar 

  11. Deakin CD, Murphy D, Couzins M, Mason S (2010) Does an advanced life support course give non-anaesthetists adequate skills to manage an airway? Resuscitation 81:539–543

    Article  PubMed  Google Scholar 

  12. Deakin CD, Peters R, Tomlinson P, Cassidy M (2005) Securing the prehospital airway: a comparison of laryngeal mask insertion and endotracheal intubation by UK paramedics. Emerg Med J 22:64–67

    Article  PubMed  CAS  Google Scholar 

  13. Dengler V, Wilde P, Byhahn C et al (2011) Präklinische Anwendung des Larynxtubus. Bietet der Larynxtubus S mit Magensonde Vorteile in der Notfallmedizin? Anaesthesist 60:135–138

    Article  PubMed  CAS  Google Scholar 

  14. Frass M, Frenzer R, Zdrahal F et al (1987) The esophageal tracheal combitube: preliminary results with a new airway for CPR. Ann Emerg Med 16:768–772

    Article  PubMed  CAS  Google Scholar 

  15. Gaitini LA, Vaida SJ, Somri M et al (2004) A randomized controlled trial comparing the ProSeal laryngeal mask airway with the laryngeal tube suction in mechanically ventilated patients. Anesthesiology 101:316–320

    Article  PubMed  Google Scholar 

  16. Genzwuerker HV, Finteis T, Wegener S et al (2010) Inzidenz der endotrachealen Intubation im Notarztdienst: adäquate Erfahrung ohne klinische Routine kaum möglich. Anaesth Intensivmed 51:202–210

    Google Scholar 

  17. Genzwurker H, Isovic H, Finteis T et al (2002) Equipment of physician-staffed ambulance systems in the state of Baden-Wuerttemberg. Anaesthesist 51:367–373

    Article  PubMed  CAS  Google Scholar 

  18. Genzwurker H, Lessing P, Ellinger K et al (2007) Infrastructure of emergency medical services. Comparison of physician-staffed ambulance equipment in the state of Baden-Wuerttemberg in 2001 and 2005. Anaesthesist 56:665–672

    Article  PubMed  CAS  Google Scholar 

  19. Gries A, Zink W, Bernhard M et al (2006) Realistische Bewertung des Notarztdienstes in Deutschland. Anaesthesist 55:1080–1086

    Article  PubMed  CAS  Google Scholar 

  20. Heidegger T, Gerig HJ, Keller C (2003) Vergleich von Algorithmen für das Management des schwierigen Atemwegs. Anaesthesist 52:381–392

    Article  PubMed  CAS  Google Scholar 

  21. Jackson KM, Cook TM (2007) Evaluation of four airway training manikins as patient simulators for the insertion of eight types of supraglottic airway devices. Anaesthesia 62:388–393

    Article  PubMed  CAS  Google Scholar 

  22. Johnston BD, Seitz SR, Wang HE (2006) Limited opportunities for paramedic student endotracheal intubation training in the operating room. Acad Emerg Med 13:1051–1055

    Article  PubMed  Google Scholar 

  23. Keller C, Brimacombe J, Kleinsasser A, Loeckinger A (2000) Does the ProSeal laryngeal mask airway prevent aspiration of regurgitated fluid? Anesth Analg 91:1017–1020

    Article  PubMed  CAS  Google Scholar 

  24. Klaver NS, Kuizenga K, Ballast A, Fidler V (2007) A comparison of the clinical use of the laryngeal tube S and the ProSeal laryngeal mask airway by first-month anaesthesia residents in anaesthetised patients. Anaesthesia 62:723–727

    Article  PubMed  CAS  Google Scholar 

  25. Lecky F, Bryden D, Little R et al (2008) Emergency intubation for acutely ill and injured patients. Cochrane Database Syst Rev:CD001429

    Google Scholar 

  26. Mann V, Brammen D, Brenck F et al (2011) Innovative Techniken in der präklinischen Notfallmedizin in Deutschland – Eine Onlineerhebung unter den Ärztlichen Leitern Rettungsdienst. Anaesth Intensivmed 52:824–833

    Google Scholar 

  27. Mann V, Mann S, Rupp D et al (2012) Einfluss von Kopfposition und Muskelrelaxierung auf die Effektivität der supraglottischen Atemwegssicherung – Eine prospektive randomisierte Studie zum Vergleich des LTS™-Larynxtubus mit der ProSeal™-Larynxmaske. Notfall Rettungsmed 15:136–141

    Article  Google Scholar 

  28. Paal P, Neurauter A, Loedl M et al (2009) Effects of stomach inflation on haemodynamic and pulmonary function during cardiopulmonary resuscitation in pigs. Resuscitation 80:365–371

    Article  PubMed  Google Scholar 

  29. Paal P, Schmid S, Herff H et al (2009) Excessive stomach inflation causing gut ischaemia. Resuscitation 80:142

    Article  PubMed  Google Scholar 

  30. Russo SG, Zink W, Herff H, Wiese CH (2010) Tod durch (k)einen Atemweg – Trauma durch die präklinische Atemwegssicherung? Anaesthesist 59:929–939

    Article  PubMed  CAS  Google Scholar 

  31. Schmid M, Mang H, Ey K, Schuttler J (2009) Prehospital airway management on rescue helicopters in the United Kingdom. Anaesthesia 64:625–631

    Article  PubMed  CAS  Google Scholar 

  32. Schmid M, Schuttler J, Ey K et al (2011) Equipment for pre-hospital airway management on Helicopter Emergency Medical System helicopters in central Europe. Acta Anaesthesiol Scand 55:583–587

    Article  PubMed  CAS  Google Scholar 

  33. Schmid MC, Deisenberg M, Strauss H et al (2006) Equipment of a land-based emergency medical service in Bavaria: a questionnaire. Anaesthesist 55:1051–1057

    Article  PubMed  CAS  Google Scholar 

  34. Schmid MC, Mang H, Ey K et al (2009) Airway management in the German air rescue service. Anaesthesist 58:884–890

    Article  PubMed  CAS  Google Scholar 

  35. Sharma V, Verghese C, McKenna PJ (2010) Prospective audit on the use of the LMA-Supreme for airway management of adult patients undergoing elective orthopaedic surgery in prone position. Br J Anaesth 105:228–232

    Article  PubMed  CAS  Google Scholar 

  36. Shin SD, Ahn KO, Song KJ et al (2012) Out-of-hospital airway management and cardiac arrest outcomes: a propensity score matched analysis. Resuscitation 83:313–319

    Article  PubMed  Google Scholar 

  37. Timmermann A (2011) Supraglottic airways in difficult airway management: successes, failures, use and misuse. Anaesthesia 66(Suppl 2):45–56

    Article  PubMed  Google Scholar 

  38. Timmermann A, Braun U, Panzer W et al (2007) Präklinisches Atemwegsmanagement in Norddeutschland: individuelle Kenntnisse, Vorgehen und Ausrüstung. Anaesthesist 56:328–334

    Article  PubMed  CAS  Google Scholar 

  39. Timmermann A, Byhahn C, Wenzel V et al (2012) Handlungsempfehlung für das präklinische Atemwegsmanagement. Für Notärzte und Rettungsdienstpersonal. Anaesth Intensivmed 53:294–308

    Google Scholar 

  40. Timmermann A, Eich C, Russo SG et al (2006) Prehospital airway management: a prospective evaluation of anaesthesia trained emergency physicians. Resuscitation 70:179–185

    Article  PubMed  Google Scholar 

  41. von Goedecke A, Herff H, Paal P et al (2007) Field airway management disasters. Anesth Analg 104:481–483

    Article  Google Scholar 

  42. Wang HE, Kupas DF, Hostler D et al (2005) Procedural experience with out-of-hospital endotracheal intubation. Crit Care Med 33:1718–1721

    Article  PubMed  Google Scholar 

  43. Wang HE, Seitz SR, Hostler D, Yealy DM (2005) Defining the learning curve for paramedic student endotracheal intubation. Prehosp Emerg Care 9:156–162

    Article  PubMed  CAS  Google Scholar 

  44. Wang HE, Szydlo D, Stouffer JA et al (2012) Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest. Resuscitation 83:1061–1066

    Article  PubMed  Google Scholar 

  45. Wenzel V, Idris AH, Banner MJ et al (1998) Respiratory system compliance decreases after cardiopulmonary resuscitation and stomach inflation: impact of large and small tidal volumes on calculated peak airway pressure. Resuscitation 38:113–118

    Article  PubMed  CAS  Google Scholar 

  46. Wirtz DD, Ortiz C, Newman DH, Zhitomirsky I (2007) Unrecognized misplacement of endotracheal tubes by ground prehospital providers. Prehosp Emerg Care 11:213–218

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Anaesthesiologie, operative Intensivmedizin, Schmerztherapie, Universitätsklinikum Gießen und Marburg GmbH, Campus Gießen, Rudolf-Buchheim-Str. 7, 35382, Gießen, Deutschland

    V. Mann, R. Röhrig, M.A. Weigand &  M. Müller

  2. Abteilung Allgemeine Orthopädie, Orthopädische Klinik, Marienstift Arnstadt, Arnstadt, Deutschland

    S.T Mann

  3. Radiologie, Universitätsklinikum Gießen und Marburg GmbH, Campus Gießen, Gießen, Deutschland

    E. Alejandre-Lafont

Authors
  1. V. Mann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S.T Mann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Alejandre-Lafont
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Röhrig
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M.A. Weigand
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Müller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mann, V., Mann, S., Alejandre-Lafont, E. et al. Supraglottische Atemwegshilfen in der Notfallmedizin. Anaesthesist 62, 285–292 (2013). https://doi.org/10.1007/s00101-013-2154-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-013-2154-1

Schlüsselwörter

Keywords

Search

Navigation