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Update 2022: Interdisziplinäre Stellungnahme zum Atemwegsmanagement mit supraglottischen Atemwegshilfen in der Kindernotfallmedizin – die Larynxmaske ist und bleibt State of the Art

Gemeinsame Stellungnahme des Instituts für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, der Sektion Pädiatrische Intensiv- und Notfallmedizin der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), des Ärztlicher Leiter Rettungsdienst Bayern (ÄLRD Bayern), des Wissenschaftlichen Arbeitskreises Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), des Wissenschaftlichen Arbeitskreises Notfallmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) und der Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI)

Update 2022: interdisciplinary statement on airway management with supraglottic airway devices in pediatric emergency medicine—The laryngeal mask is and remains state of the art

Joint statement of the Institute for Emergency Medicine and Medicine Management (INM), the University Clinic Munich, LMU Munich, Germany, the Working Group for Pediatric Critical Care and Emergency Medicine of the German Interdisciplinary Society for Critical Care and Emergency Medicine (DIVI), the Medical Directors of Emergency Medical Services in Bavaria (ÄLRD), the Scientific Working Group for Pediatric Anesthesia (WAKKA) of the German Society for Anesthesiology and Intensive Care Medicine (DGAI), the Scientific Working Group for Emergency Medicine of the German Society for Anesthesiology and Intensive Care Medicine (DGAI) and the Society of Neonatology and Pediatric Critical Care Medicine (GNPI)

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Zusammenfassung

Hintergrund

Das Atemwegsmanagement mit supraglottischen Atemwegshilfen (SGA) bei lebensbedrohlichen Kindernotfällen stellt eine der Hauptsäulen des Notfallatemwegsmanagements dar. Hierbei kommen unterschiedliche Arten von Larynxmasken (LM) und Larynxtuben (LT) zum Einsatz. Auf der Basis einer aktualisierten, umfassenden Literaturauswertung wird ein Update der 2015 erstmalig publizierten, interdisziplinären Stellungnahme zum Einsatz von SGA bei Kindernotfällen präsentiert.

Material und Methoden

Literaturrecherche über die Datenbank „PubMed“ und Einordnung der Studien analog den Kriterien des Oxford Centre for Evidence-based Medicine – Levels of Evidence (bis 31.12.2020) sowie anschließende Konsensusfindung innerhalb der Autor*Innen-Gruppe.

Ergebnisse

Die Evidenz zum erfolgreichen Einsatz der LM im Kindesalter wird zunehmend größer, und LM werden mittlerweile auch für die Neugeborenenversorgung empfohlen. Erfolgreiche Anwendungen des LT beschränken sich weiterhin auf wenige Arbeitsgruppen und Zentren sowie eine insgesamt geringe Anzahl von Anwendungen. Vor allem für Kinder unter 10 kgKG erscheint eine Anwendung des LT weiterhin nicht sicher und kann daher nicht empfohlen werden. Ein für die Notfallbeatmung verwendeter SGA sollte über die Möglichkeit eines gastralen Kanals (2. Generations-SGA) verfügen.

Diskussion

Unter Berücksichtigung der wissenschaftlichen Datenlage und der großen klinischen Erfahrung mit der LM in der Elektiv- und Notfallanwendung bei Neugeborenen und Kindern kann derzeit zum notfallmäßigen Atemwegsmanagement im Kindesalter von den supraglottischen Atemwegshilfen nur die Larynxmaske empfohlen werden. Die Larynxmaske sollte sowohl prähospital als auch innerklinisch in allen für Kinder verfügbaren Größen (1, 1½, 2, 2½, 3) vorgehalten und in der Anwendung regelmäßig geschult werden.

Abstract

Background

Airway management with supraglottic airway devices (SGA) in life-threatening emergencies in children is increasingly being used. Different specifications of laryngeal masks (LM) and the laryngeal tube (LT) are commonly used devices for this purpose. We present a literature review and interdisciplinary consensus statement of different societies on the use of SGA in pediatric emergency medicine.

Material and methods

Literature review in the PubMed database and classification of studies according to the criteria of the Oxford Centre for Evidence-based Medicine. Levels and consensus finding within the group of authors.

Results

The evidence for successful applications of the various types of LM is significantly higher than for LT application. Reported smaller series of successful applications of LT are currently limited to selected research groups and centers. Especially for children below 10 kg body weight there currently exists insufficient evidence for the successful application of the LT and therefore its routine use cannot be recommended. SGAs used for emergencies should have a gastric drainage possibility.

Discussion

Considering the scientific data and the large clinical experience with the LM in medical routine and emergency situations in children currently only the LM can be recommended for alternative (i.e., non-intubation) emergency airway management in children. If alternative airway management is part of a local emergency strategy, the LM should be provided in all pediatric sizes (1, 1½, 2, 2½, 3) for out of hospital use and in hospital emergency use and all users should regularly be trained in its application.

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Authors and Affiliations

  1. Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, München, Deutschland

    J. Güth & B. Urban

  2. Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland

    P. Jung, C. Eich, B. Landsleitner, B. Hossfeld, M. Olivieri &  F. Hoffmann

  3. Ärztliche Leitung, Rettungsdienst Bayern (ÄLRD Bayern), München, Deutschland

    A. Schiele, A. Parsch & B. Matsche

  4. Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland

    C. Eich, K. Becke-Jakob, B. Landsleitner & S. G. Russo

  5. Wissenschaftlicher Arbeitskreis Notfallmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland

    M. Bernhard

  6. Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI), Berlin, Deutschland

    F. Hoffmann

  7. Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Institut für Notfallmedizin und Medizinmanagement (INM), Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland

    F. Hoffmann

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  1. J. Güth
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  2. P. Jung
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  3. A. Schiele
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  4. B. Urban
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  6. B. Matsche
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  7. C. Eich
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  8. K. Becke-Jakob
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  9. B. Landsleitner
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  10. S. G. Russo
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  11. M. Bernhard
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  13. M. Olivieri
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  14. F. Hoffmann
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Correspondence to F. Hoffmann.

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J. Güth, P. Jung, A. Schiele, B. Urban, A. Parsch, B. Matsche, C. Eich, K. Becke-Jakob, B. Landsleitner, S.G. Russo, M. Bernhard, B. Hossfeld, M. Olivieri und F. Hoffmann geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Güth, J., Jung, P., Schiele, A. et al. Update 2022: Interdisziplinäre Stellungnahme zum Atemwegsmanagement mit supraglottischen Atemwegshilfen in der Kindernotfallmedizin – die Larynxmaske ist und bleibt State of the Art. Anaesthesiologie 72, 425–432 (2023). https://doi.org/10.1007/s00101-023-01284-2

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  • DOI: https://doi.org/10.1007/s00101-023-01284-2

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