Elsevier

Resuscitation

Volume 61, Issue 2, May 2004, Pages 149-153
Resuscitation

Airway management in cardiac arrest—comparison of the laryngeal tube, tracheal intubation and bag-valve mask ventilation in emergency medical training

https://doi.org/10.1016/j.resuscitation.2004.01.014Get rights and content

Abstract

Tracheal intubation (ETI) is considered the method of choice for securing the airway and for providing effective ventilation during cardiac arrest. However, ETI requires skills which are difficult to maintain especially if practised infrequently. The laryngeal tube (LT) has been successfully tested and used in anaesthesia and in simulated cardiac arrest in manikins. To compare the initiation and success of ventilation with the LT, ETI and bag-valve mask (BVM) in a cardiac arrest scenario, 60 fire-fighter emergency medical technician (EMT) students formed teams of two rescuers at random and were allocated to use these devices. We found that the teams using the LT were able to initiate ventilation more rapidly than those performing ETI (P<0.0001). The LT and ETI provided equal minute volumes of ventilation, which was significantly higher than that delivered with the BVM (P<0.0001). Our data suggest that the LT may enable airway control more rapidly and as effectively as ETI, and compared to BVM, may provide better minute ventilation when used by inexperienced personnel.

Sumàrio

A entubação traqueal (ETI) é considerada o método de escolha para assegurar a permeabilidade da via aérea e ventilação eficaz durante a paragem cardı́aca. No entanto, a ETI exige aptidões difı́ceis de manter especialmente se praticadas com pouca frequência. A máscara ları́ngea (LT) tem sido testada com sucesso e utilizada em anestesia e na paragem cardı́aca simulada em manequins. Para comparar o inı́cio e o sucesso da ventilação com LT, ETI e máscara com insuflador (BVM) num cenário de paragem cardı́aca, recrutamos 60 bombeiros em treino de técnicas de emergência médica (EMT), que foram agrupados em equipas de 2 reanimadores ao acaso e foram alocados ao uso destes dispositivos. As equipes utilizando a LT foram capazes de iniciar a ventilação mais rapidamente do que os que realizaram ETI (P<0.0001). A LT e a ETI proporcionaram volumes minuto iguais e significativamente superiores aos produzidos com a BVM (P<0.0001). Os nossos dados sugerem que a LT pode proporcionar um controle da via aérea mais rápido e tão eficaz como a ETI e, quando comparada com a BVM, pode assegurar melhor ventilação minuto quando utilizada por pessoal inexperiente.

Resumen

La intubación traqueal (ETI) es considerado el método de elección para asegurar la vı́a aérea y proporcionar ventilación efectiva durante el paro cardı́aco. Sin embargo, ETI requiere destrezas que son difı́ciles de mantener, especialmente si son practicadas poco frecuentemente. El tubo ları́ngeo (LT) ha sido probado y usado exitosamente en anestesia y en paro cardı́aco simulado en maniquı́es. Para comparar la iniciación y éxito de la ventilación con LT, ETI y dispositivo mascara- bolsa- válvula (BVM) en un escenario de paro cardı́aco, 60 estudiantes de técnico en emergencias médicas (EMT) de bomberos formaron equipos de a dos reanimadores en forma aleatoria y fueron asignados al uso de los dispositivos. Encontramos que los equipos que usaron el LT fueron capaces de iniciar la ventilación en forma más rápida que aquellos que realizaron ETI (P<0.0001). El LT y ETI proporcionaron igual volumen ventilación minuto, el que fue significativamente mayor que el entregado con la BVM (P<0.0001). Nuestros datos sugieren que el LT puede permitir control de vı́a aérea mas rápidamente y en forma tan efectiva como la ETI, y comparado a BVM, puede proporcionar mejor ventilación minuto cuando es usado por personal con poca experiencia.

Introduction

Successful management of the patient in cardiac arrest includes adequate oxygenation and ventilation. Health care professionals are instructed to use bag-valve mask (BVM) ventilation, and the “gold standard” of securing the airway is considered to be tracheal intubation (ETI) [1]. Because the BVM and ETI require special skills, and both methods have been shown to be difficult even for health care professionals [2], [3], alternative devices for airway management have been investigated. One of these is the laryngeal tube (LT, VBM Medizinteknik Sulz a.N-Germany GmbH), a new device which is inserted blindly into the oropharynx of the patient [4]. It has been tested successfully and used in simulated cardiac arrest in manikins and anaesthesia [5], [6]. We wanted to evaluate the value of the LT as the initial method of establishing an open airway and starting ventilation in a simulated cardiac arrest situation. The aim of the study was to compare the speed of initiation and the effectiveness of ventilation using the LT, ETI and BMV as part of the basic training of fire-fighter students.

Section snippets

Methods

The section on airway management in the curriculum for airway management for fire-fighter emergency medical technicians (EMTs) at the national Emergency Services College in Kuopio, Finland, consists of 20 h didactic lessons and simulations. It includes application of the BVM using a one-person technique to assist ventilation, and ETI to secure the airway in a cardiac arrest situation. In a cardiac arrest call attended by two rescuers, one EMT clears the airway while the other one performs

Results

On the day of the test, two students reported ill, leaving 29 pairs to complete the test. All teams carried out the test according to the protocol. Initial evaluation of the patient was equally fast among all teams, and the first defibrillatory shock was delivered in less than 61 s from the beginning of the test in all groups (Fig. 1). Nineteen teams were allocated to insert the LT, 19 teams to perform ETI and 20 teams to use BVM ventilation. All teams successfully inserted the LT or performed

Discussion

In this test situation, clinically inexperienced EMT students successfully inserted the LT or performed ETI in a manikin. Compared with BVM, minute ventilation was significantly higher with both the LT and ETI. The results confirm those presented in a recent study, describing experienced clinicians evaluating ventilation with the same devices in simulated CPR [7]. In the present study, which also focused on timing in the management of the “patient”, the speed of initiation of ventilation was

Conclusions

In a simulated cardiac arrest situation, clinically inexperienced EMT students successfully inserted the LT or performed ETI. Initiation of ventilation was faster with the LT than with ETI. Compared with BVM, the LT provided better minute ventilation during CPR. The value of the LT as the initial device to manage the airway in cardiac arrest requires assessment in clinical trials.

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