scholarly journals Utility of a Gum-Elastic Bougie for Difficult Airway Management in Infants: A Simulation-Based Crossover Analysis

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Nobuyasu Komasawa ◽  
Akira Hyoda ◽  
Sayuri Matsunami ◽  
Nozomi Majima ◽  
Toshiaki Minami
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Success Rate ◽  
Difficult Airway Management ◽  
Intubation Time ◽  
Simulation Based ◽  
Intubation Success ◽  
Intubation Success Rate ◽  
Crossover Analysis ◽  
Airway Model

Background.Direct laryngoscopy with the Miller laryngoscope (Mil) for infant tracheal intubation is often difficult to use even for skilled professionals. We performed a simulation trial evaluating the utility of a tracheal tube introducer (gum-elastic bougie (GEB)) in a simulated, difficult infant airway model. Methods.Fifteen anesthesiologists performed tracheal intubation on an infant manikin at three different degrees of difficulty (normal [Cormack-Lehane grades (Cormack) 1-2], cervical stabilization [Cormack 2-3], and anteflexion [Cormack 3-4]) with or without a GEB, intubation success rate, and intubation time.Results.In the normal and cervical stabilization trials, all intubation attempts were successful regardless of whether or not the GEB was used. In contrast, only one participant succeeded in tracheal intubation without the GEB in the anteflexion trial; the success rate significantly improved with the GEB (P=0.005). Intubation time did not significantly change under the normal trial with or without the GEB (without, 12.7 ± 3.8 seconds; with, 13.4 ± 3.6 seconds) but was significantly shorter in the cervical stabilization and anteflexion trials with the GEB.Conclusion.GEB use shortened the intubation time and improved the success rate of difficult infant tracheal intubation by anesthesiologists in simulations.

scholarly journals Comparison of Direct and Indirect Laryngoscopes in Vomitus and Hematemesis Settings: A Randomized Simulation Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Ryosuke Mihara ◽  
Nobuyasu Komasawa ◽  
Sayuri Matsunami ◽  
Toshiaki Minami
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Macintosh Laryngoscope ◽  
Intubation Time ◽  
Direct Laryngoscope ◽  
Mcgrath Mac ◽  
Significant Difference ◽  
Intubation Success ◽  
Intubation Success Rate

Background.Videolaryngoscopes may not be useful in the presence of hematemesis or vomitus. We compared the utility of the Macintosh laryngoscope (McL), which is a direct laryngoscope, with that of the Pentax-AWS Airwayscope (AWS) and McGRATH MAC (McGRATH), which are videolaryngoscopes, in simulated hematemesis and vomitus settings.Methods.Seventeen anesthesiologists with more than 1 year of experience performed tracheal intubation on an adult manikin using McL, AWS, and McGRATH under normal, hematemesis, and vomitus simulations.Results.In the normal setting, the intubation success rate was 100% for all three laryngoscopes. In the hematemesis settings, the intubation success rate differed significantly among the three laryngoscopes (P=0.021). In the vomitus settings, all participants succeeded in tracheal intubation with McL or McGRATH, while five failed in the AWS trial with significant difference (P=0.003). The intubation time did not significantly differ in normal settings, while it was significantly longer in the AWS trial compared to McL or McGRATH trial in the hematemesis or vomitus settings (P<0.001, compared to McL or McGRATH in both settings).Conclusion.The performance of McGRATH and McL can be superior to that of AWS for tracheal intubation in vomitus and hematemesis settings in adults.

scholarly journals Comparison of Different Intubation Methods in Difficult Airways during Simulated Cardiopulmonary Resuscitation with Continuous Chest Compression: A Randomized Cross-Over Manikin Trial

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Togay Evrin ◽  
Jacek Smereka ◽  
Damian Gorczyca ◽  
Szymon Bialka ◽  
Jerzy Robert Ladny ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Airway Management ◽  
Success Rate ◽  
Endotracheal Intubation ◽  
Chest Compression ◽  
Macintosh Laryngoscope ◽  
Intubation Time ◽  
Intubation Success ◽  
Intubation Success Rate ◽  
Difficult Airways

Introduction. Airway management is one of key elements of resuscitation. Endotracheal intubation is still considered the gold standard for airway management during resuscitation. Aim. The aim of the study was to compare success rates and intubation time of different endotracheal intubation methods during emergency intubation with difficult airways in the conditions of cardiopulmonary resuscitation in a standardized manikin model. Methods. The study was designed as a prospective, randomized, cross-over simulation study. It involved 46 paramedics with at least 5 years of experience in Emergency Medical Service. The participants performed endotracheal intubation under difficult airway conditions during continuous chest compression, implemented with the LUCAS3 chest compression system. Three methods of tracheal intubation were applied: (1) standard Macintosh laryngoscope without a bougie stylet; (2) standard laryngoscope and a standard bougie stylet; (3) standard laryngoscope and a new bougie stylet. Results. The overall intubation success rate was 100% in the standard bougie and new bougie groups and lower (86.9%) when no bougie stylet was used (P=0.028). The intubation success rate with the 1st attempt equalled 91.3% for the new bougie group, 73.9% for standard bougie, and only 23.9% in the no-bougie group. The median intubation time was shortest in the new bougie group, where it amounted to 29 s (interquartile range [IQR]: 25–38); the time equalled 38s (IQR:31–44.5) in the standard bougie group and 47.5s (IQR:36–58) in the no-bougie group. The ease of use was lowest in the no-bougie group (85, IQR:63–88), average in the standard bougie group (44, IQR:30–51), and highest in the new bougie stylet group (32, IQR:19–41). Conclusion. In this manikin-based study, paramedics were able to perform endotracheal intubation with higher efficacy and in a shorter time using the new bougie stylet as compared with the standard bougie stylet.

scholarly journals Analysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Jürgen Knapp ◽  
Bettina Eberle ◽  
Michael Bernhard ◽  
Lorenz Theiler ◽  
Urs Pietsch ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Quality Control ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Success Rate ◽  
Video Laryngoscope ◽  
Solar Irradiation ◽  
Video Laryngoscopy ◽  
Trauma Patients ◽  
Intubation Success

Abstract Background Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative. Methods We conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy. Results FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified. Conclusion Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.

scholarly journals Comparison of ILMA Guided Tracheal Intubation in the Lateral Position with the Supine Position

2013 ◽  
Vol 3 (4) ◽  
pp. 32-38
Author(s):  
Manish Naithani ◽  
Kirti N Saxena ◽  
Prachi Gaba ◽  
C K Dua
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Supine Position ◽  
Clinical Investigation ◽  
Medical Science ◽  
Mucosal Injury ◽  
Lateral Position ◽  
Categorical Variables ◽  
Intubation Time ◽  
Intubation Success

Background: The ILMA has been established as a valuable airway management device in the supine position, in both elective and emergency situations, for both ventilation and intubation. Intubation in lateral position might be necessary in some congenital syndromes, morbid obesity, or after accidental extubation in laterally positioned patients. This study was undertaken to evaluate the ILMA for intubation of patients in the lateral position and compare it with intubation in the supine position. Aims: To determine and compare the success rate, time taken, and complications of intubation with the ILMA in the lateral versus supine position. Settings and Design: Prospective, clinical investigation, in a tertiary level, multispecialty hospital. Methods and Material: Seventy ASA I-II patients scheduled for elective surgeries were randomly allocated into two groups of 35 patients each. The groups F1 and F2 consisted of patients who were intubated with the ILMA in the supine and lateral positions, respectively. The comparison of the two positions was based on: success of intubation, success at first attempt, number of attempts, intubation time, and incidences of oesophageal intubation, oxygen desaturation, mucosal injury and postoperative sore throat. Statistical Analysis used: The data was analysed, and for comparison of mean between two groups, unpaired student “t”-test was applied. ?2-test or Fischer exact test were applied for categorical variables like number of attempts, incidence of mucosal injury etc. Results: The intubation success rate was 100% in both positions. The success rate of intubation in the first attempt was 97.1% in supine, and 94.3% in the lateral position, and was comparable. The average intubation time was significantly more in the lateral, as compared to the supine position (45.82 versus 38.51 seconds). The incidence of intra, and post-operative complications was low in both the positions. Conclusion: These results suggest that the ILMA is a useful device for tracheal intubation in the lateral position. The difference in intubation time, though significantly more (statistically) in the lateral as compared to the supine position, had little clinical relevance. DOI: http://dx.doi.org/10.3126/ajms.v3i4.5667 Asian Journal of Medical Science Vol.3(4) 2012 pp.32-38

Physician-staffed helicopter emergency medical services augment ground ambulance paediatric airway management in urban areas: a retrospective cohort study

2019 ◽  
Vol 36 (11) ◽  
pp. 678-683 ◽  
Author(s):  
Alan A Garner ◽  
Nicholas Bennett ◽  
Andrew Weatherall ◽  
Anna Lee
Keyword(s):  
Airway Management ◽  
Emergency Medical Services ◽  
Success Rate ◽  
Urban Area ◽  
Neuromuscular Blockade ◽  
Urban Areas ◽  
Large Urban Area ◽  
Advanced Airway ◽  
Intubation Success ◽  
Intubation Success Rate

ObjectivesPaediatric intubation is a high-risk procedure for ground emergency medical services (GEMS). Physician-staffed helicopter EMS (PS-HEMS) may bring additional skills, drugs and equipment to the scene including advanced airway management beyond the scope of GEMS even in urban areas with short transport times. This study aimed to evaluate prehospital paediatric intubation performed by a PS-HEMS when dispatched to assist GEMS in a large urban area and examine how often PS-HEMS provided airway intervention that was not or could not be provided by GEMS.MethodsWe performed a retrospective observational study from July 2011 to December 2016 of a PS-HEMS in a large urban area (Sydney, Australia), which responds in parallel to GEMS. GEMS intubate without adjuvant neuromuscular blockade, whereas the PS-HEMS use neuromuscular blockade and anaesthetic agents. We examined endotracheal intubation success rate, first-look success rate and complications for the PS-HEMS and contrasted this with the advanced airway interventions provided by GEMS prior to PS-HEMS arrival.ResultsOverall intubation success rate was 62/62 (100%) and first-look success was 59/62 (95%) in the PS-HEMS-treated group, whereas the overall success rate was 2/7 (29%) for the GEMS group. Peri-intubation hypoxia was documented in 5/65 (8%) of the PS-HEMS intubation attempts but no other complications were reported. However, 3/7 (43%) of the attempted intubations by GEMS were oesophageal intubations, two of which were unrecognised.ConclusionsPS-HEMS have high success with low complication rates in paediatric prehospital intubation. Even in urban areas with rapid GEMS response, PS-HEMS activated in parallel can provide safe and timely advanced prehospital airway management for seriously ill and injured children beyond the scope of GEMS practice. Review of GEMS airway management protocols and the PS-HEMS case identification and dispatch system in Sydney is warranted.

scholarly journals Analysis of Tracheal Intubation in Out-of-Hospital Helicopter Emergency Medicine Recorded by Video Laryngoscopy.

2020 ◽  
Author(s):  
Jürgen Knapp ◽  
Bettina Eberle ◽  
Michael Bernhard ◽  
Lorenz Theiler ◽  
Urs Pietsch ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Quality Control ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Success Rate ◽  
Video Laryngoscope ◽  
Solar Irradiation ◽  
Video Laryngoscopy ◽  
Trauma Patients ◽  
Intubation Success

Abstract Objective. Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success and especially first-pass intubation success (FPS) in these situations is imperative.Methods. We conducted a prospective observational study on all twelve helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, as well as circumstances and environmental factors, and the level of experience in airway management of the provider had to be filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy.Results. FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p<0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified.Conclusion. Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.

scholarly journals Optimising tracheal intubation success rate using the Airtraq laryngoscope

Anaesthesia ◽  
2009 ◽  
Vol 64 (3) ◽  
pp. 315-319 ◽  
Author(s):  
G. Dhonneur ◽  
W. Abdi ◽  
R. Amathieu ◽  
S. Ndoko ◽  
L. Tual
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Intubation Success ◽  
Intubation Success Rate

scholarly journals The retrograde tracheal intubation technique for difficult airway management

2019 ◽  
Vol 3 (2) ◽  
pp. e16 ◽  
Author(s):  
Vincenzo Marchello ◽  
Ruggero M. Corso ◽  
Emanuele Piraccini ◽  
Alfredo Del Gaudio ◽  
Giuseppe Mincolelli ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Difficult Airway ◽  
Difficult Airway Management ◽  
Intubation Technique
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