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

      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.

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