Zusammenfassung
HINTERGRUND: Im Jahr 2005 veröffentlichte der European Resuscitation Council die neuen Richtlinien für "Advanced Life Support". Eines der Ziele ist die Reduzierung der so genannten "No-Flow-Zeit", definiert als die Zeit, in der während des Herz-Kreislauf-Stillstandes keine Herzdruckmassage stattfindet. Wir überprüften in einer Studie am Reanimationsphantom während eines simulierten Herz-Kreislaufstillstandes, ob der Gebrauch des Larynxtubus als supraglottische Sicherung des Atemweges im Vergleich zum Endotrachealtubus die "No Flow Zeit" in der ersten Phase der Reanimation verringern kann. METHODEN: In die prospektive Untersuchung wurden 50 Teilnehmer eines standardisierten eintägigen Reanimationskurses eingeschlossen. Die Teilnehmer haben alle die obligatorische notfallmedizinische Ausbildung, praktizieren allerdings die endotracheale Intubation nicht regelmäßig. Die Teilnehmer der Untersuchung galten entsprechend den aktuellen Leitlinien des European Resuscitation Council als unerfahren in der endotrachealen Intubation zur Atemwegsicherung. Wir definierten zwei Untersuchungsgruppen (LT-Gruppe: Nutzung des Larynxtubus zur Sicherung der Atemwege während des Szenarios; ET-Gruppe: Nutzung des Endotrachealtubus und der Beutel-Masken-Ventilation zur Sicherung der Atemwege und zur Beatmung des Phantoms). Alle Teilnehmer wurden randomisiert zunächst einer der beiden Gruppen zugeordnet und absolvierten danach das jeweils andere Szenario. Studienendpunkte waren die gesamte "No Flow Zeit" sowie die Einhaltung der Leitlinien des European Resuscitation Council aus dem Jahr 2005. ERGEBNISSE: Die Anwendung des Larynxtubus reduzierte, verglichen mit dem Endotrachealtubus, im dargestellten Szenario signifikant die "No Flow Zeit" (109,3 vs. 190,4 Sekunden; p < 0,01). Der Gebrauch des Larynxtubus führte signifikant schneller zu einer Sicherung der Atemwege als der Endotrachealtubus (13 s vs. 52 s; p < 0,01). Der Larynxtubus konnte von 98% der Teilnehmer im ersten Versuch erfolgreich platziert werden; bei Nutzung des Endotrachealtubus waren 72% im ersten Versuch erfolgreich. SCHLUSSFOLGERUNG: In unserem Reanimationsszenario am Simulator konnte durch den Gebrauch des Larynxtubus die "No Flow Zeit" im Vergleich zum Endotrachealtubus in der ersten Phase der Reanimation signifikant verringert werden. Im Sinne der Leitlinien des European Resuscitation Council sind wir überzeugt, dass Notfallmediziner, die in der Anwendung des Endotrachealtubus nicht sicher sind, in Reanimationssituationen primär supraglottische Hilfen zur Sicherung der Atemwege (in der vorliegenden Studie der Larynxtubus) verwenden sollten.
Summary
In 2005 the European Resuscitation Council published new guidelines for advanced life support. One of the issues was to reduce the "no flow time", which is defined as the time without chest compression in the first period of cardiac arrest. In a manikin study, we evaluated whether using the laryngeal tube instead of endotracheal intubation for airway management during cardiac arrest could reduce the "no flow time". METHODS: The study was prospective and included 50 volunteers who performed standardized management of simulated cardiac arrest in a manikin. All participants had completed an obligatory course in emergency medicine but had not been specifically trained in endotracheal intubation; they were therefore designated as unfamiliar in using the endotracheal tube to secure the airway, in accordance with the definition of the European Resuscitation Council. We defined two groups for the study: the LT group, who used the laryngeal tube to secure the airway; and the ET group, who used the endotracheal tube and bag-mask ventilation to ventilate the manikin. The participants were initially randomly assigned to one of the groups and thereafter completed the other scenario. Study endpoints were the total "no flow time" and adherence to guidelines of the European Resuscitation Council. RESULTS: Use of the laryngeal tube during cardiac arrest in the manikin significantly reduced the "no flow time" when compared with endotracheal intubation (109.3 s vs. 190.4 s; P < 0.01). The laryngeal tube was inserted significantly faster than the endotracheal tube (13 s vs. 52 s; P < 0.01) and was correctly positioned by 98% of the participants at the first attempt, compared with 72% using the endotracheal tube. CONCLUSION: With regard to the guidelines of the European Resuscitation Council, we are convinced that during cardiac arrest supraglottic airway devices should be used by emergency personnel unfamiliar with endotracheal intubation.
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Wiese, C., Bartels, U., Bergmann, A. et al. Using a laryngeal tube during cardiac arrest reduces "no flow time" in a manikin study: a comparison between laryngeal tube and endotracheal tube. Wien Klin Wochenschr 120, 217–223 (2008). https://doi.org/10.1007/s00508-008-0953-1
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DOI: https://doi.org/10.1007/s00508-008-0953-1