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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

I-gel as a first-line airway device in the emergency room for patients with out-of-hospital cardiac arrest


Aim. The optimal method for advanced airway management during cardiac arrest remains controversial. Most patients with out-of-hospital cardiac arrest (OHCA) in Korea are managed with a bag-valve mask by paramedics, while physicians perform advanced airway management in emergency departments (ED). Endotracheal intubation (ETI) has a risk of failure at the first attempt. By contrast, I-gel, a supraglottic airway device, is easier to insert than an endotracheal tube and shows a higher first-attempt success rate than ETI in out-of-hospital settings by paramedics in the United States. We reviewed the use of ETI and I-gel by ED physicians to assess the first attempt success rate in a hospital setting.

Methods. We conducted a retrospective chart review of patients with non-traumatic OHCA who were managed with either ETI using a Macintosh laryngoscope, or I-gel in the ED of Korean hospital from January 2012 to January 2014.

Results. Of 322 adult patients with non-traumatic OHCA, 160 received I-gel and 162 received ETI. The first-attempt success rate was higher in the I-gel group (96.9%) than in the ETI group (84.6%, p < 0.001). The time from arrival to obtaining advanced airway management was shorter in the I-gel group than in the ETI group.

Conclusions. I-gel showed a better first-attempt success rate and shorter insertion time compared with ETI when performed by physicians in a hospital setting.

Key words: airway management, laryngeal mask, out-of-hospital cardiac arrest, resuscitation

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The clinical effectiveness of simulation based airway management education using the Korean emergency airway registry


Introduction. Simulation training with an integrated simulator is appropriate for achieving educational goals in airway management. Thus, we designed this study to evaluate the effectiveness of a simulation based emergency airway management program (SBEAMP) in actual practice.

Method. This is a retrospective sub-group analysis of the Korean Emergency Airway Management Registry from 2006 to 2010. We categorized all hospitals into two groups. Six hospitals that actively attended SBEAMP were defined as the ‘participant group’, and the others as the ‘non-participant group’. The types of medicines administered, the use of pre-oxygenation, and the rate of first pass success were compared.

Result. The ratio of patients with no medicine received during intubation showed a decrease in both groups but was more rapid in the participant group (p<0.001). The ratio of intubation with sedatives alone was high in the non-participant group (P<0.001). The ratio of intubation with paralytics alone was high in the non-participant group (p<0.001). In the participant group, a combination of both agents was used more frequently (P<0.001). Cases of intubation with both agents and preoxygenation were more prevalent in the participant group (P<0.001).

Conclusion. We concluded in this study that SBEAMP had a positive influence on actual clinical outcomes in emergency airway management.

Key words: airway management, registry, simulation training

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The influence of different airway management strategies on chest compression fraction in simulated cardiopulmonary resuscitation, provided by paramedics: LMA Supreme versus Endotracheal Intubation and Combitube


Introduction. It is strongly advised by the European Resuscitation Council not to interrupt chest compressions for airway management. An alternative to tracheal intubation is the use of a supraglottic airway device (SAD) which should shorten “hands-off” time during cardiopulmonary resuscitation (CPR). Chest compression fraction (CCF) should be above 0.6 to ensure the probability of successful CPR. We compared the performance of airway management during CPR provided by

paramedics using the laryngeal mask (LMA) Supreme, Combitube and endotracheal intubation (ET) in a manikin model.

Materials and Methods. Thirty sophomore students of emergency medicine school for paramedics took part in the study. The primary endpoint was to assess the influence of the type of airway management on CCF. The time to successful airway management (TA) was measured and the minute ventilation was assessed using the respirator Medumat Easy and program AMBU® CPR SOFTWARE during uninterrupted CPR. CCF was measured using CPRmeter – QCPR (Laerdal).

Results. Mean CCF was significantly better for LMA Supreme (0.8 vs 0.71 vs 0.65), mean TA was significantly shorter for LMA supreme: 16.5 sec vs 24.37 sec vs 28,3 sec, the success rate in the first attempt was 100% vs 66.6% vs 100%, mean air leak during chest compressions was 14% vs 8% vs 15% for LMA Supreme, ET and Combitube respectively.

Conclusion. The LMA Supreme is an effective tool for airway management during chest compression and provides adequate ventilation.

Key words: cardiopulmonary resuscitation, airway management, endotracheal intubation, supraglottic devices

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A prospective randomized high fidelity simulation center based side-by-side comparison analyzing the success and ease of conventional versus new generation video laryngoscope technology by inexperienced laryngoscopists


Introduction. Indirect video laryngoscopes are altering the landscape of airway management.  The primary aim of this prospective randomized patient simulator analysis was to objectively compare video laryngoscopes to standard airway management techniques in novice users.
Methods.  “First year medical students were exposed to high-fidelity simulated normal and difficult airway scenarios while using an array of indirect video laryngoscopes (e.g., the GlideScope, McGRATH or Pentax AWS-100) that were compared to Macintosh laryngoscope and fiberoptic bronchoscope (i.e., historic gold standards for normal and difficult airways, respectively).”
Results.  In the normal airway scenario, the best glottic view (both subjective and objective) was obtained with the video laryngoscopes and intubation success rates were highest with the video laryngoscopes (100% success rate for each device) and Macintosh (80%).  In the difficult airway scenario, the best glottic view was achieved with all video laryngoscopes and the fiberoptic bronchoscope; however, tracheal intubation was best achieved with the video laryngoscopes (100% success rate for each device) whereas the success rate with the bronchoscope was only 36%.
Discussion.  Our findings support the use of the GlideScope, McGRATH, or Macintosh laryngoscopes for novice users managing a normal airway.  When managing the difficult airway, there was no difference between any video or Macintosh laryngoscope in the time to successfully intubate the trachea.  Over time, study participants demonstrated learned behavior as they became more facile with all devices.  When comparing the video laryngoscopes, all three performed similarly overall and proved useful in the hands of novice users.  Regardless of airway difficulty, the fiberoptic bronchoscope yielded the worst results.

Key words: airway, airway management, airway equipment, patient simulation, success, tracheal intubation

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Difficult airway management in the emergency room using an airway scope


In the emergency room, some cases need adequate airway management. We present a patient whom we intubated using a new device. This device might be an option in airway management but some considerations should also be taken into account.

Key words: airway management, sco-pe, secretions, bleeding

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