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The LMA Fastrach® as a conduit for endotracheal intubation during simulated cardiopulmonary resuscitation
YAJEM-56412; No of Pages 2 American Journal of Emergency Medicine xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
The LMA Fastrach® as a conduit for endotracheal intubation during simulated cardiopulmonary resuscitation☆ Jacek Smereka a, Lukasz Szarpak b,⁎, Jerzy R. Ladny c a b c
Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
a r t i c l e
i n f o
Article history: Received 2 January 2017 Accepted 10 January 2017 Available online xxxx
© 2017 Elsevier Inc. All rights reserved.
Sir, Securing a clear airway is one of the priorities during CPR. Endotracheal intubation remains the gold standard for airway management [1,2]; however, when carried out by inexperienced persons, it may be associated with many complications, including teeth injury, soft tissue damage and bleeding, or edema causing inability to ventilate the patient [3]. Therefore, it is reasonable to search for alternative methods of direct laryngoscopy intubation. One of such methods is using supraglottic devices as a guide for the endotracheal tube. An example of such a device may be the laryngeal mask airway LMA Fastrach (Teleflex San Diego, San Diego, CA, USA). A number of studies point at the usefulness of the laryngeal mask in difficult airway management. Baskett et al. on the basis of a multicenter study conducted in the United Kingdom, stated that the effectiveness of the first intubation attempt with LMA equaled 80%, 4% of cases required intubation with three attempts, and 4% were failures [4]. The high efficiency of the use of LMA as a guide for the endotracheal tube refers not only to intubation in operating theaters, but also in the prehospital settings [5]. The aim of the study was to evaluate the effectiveness of intubation with the use of LMA Fastrach as a guide for endotracheal tube during simulated cardiopulmonary resuscitation. The study involved 32 novice physicians. Their median age was 25.7 (interquartile range [IQR], 25–27) years, and the median work
☆ Source of support: No sources of financial and material support to be declared. ⁎ Corresponding author at: Department of Emergency Medicine, Medical University of Warsaw, 4 Lindleya Str., 02-005, Warsaw, Poland. E-mail address: [email protected] (L. Szarpak).
experience 0.6 (IQR, 0–1) years. All participants declared their ability to perform endotracheal intubation with direct laryngoscopy. Before the study, they took part in a 10-minute training on the proper introduction of LMA and performing endotracheal intubation “blindly” with the use of LMA Fastrach as a guide for the endotracheal tube. Then the study participants had the opportunity to introduce the LMA in the training manikin. In order to simulate a patient requiring cardiopulmonary resuscitation, a MegaCode Kelly™ advanced life support manikin (Laerdal Medical, Stavanger, Norway) was used. During the study, the participants were asked to perform endotracheal intubation using LMA as a guide for the endotracheal tube. Intubation was performed in two test scenarios: (A) normal airway without chest compressions; (B) normal airway with ongoing chest compression. In order to compensate for the differences resulting from manual chest compressions [6,7,8], the chest compression system Lifeline ARM (Defibtech, USA) was applied. The order of participants and of the research scenarios was random. The study participants had a maximum of three intubation attempts in each scenario. The overall efficacy of intubation with LMA for scenario A and B was 93.7% and 84.4%, respectively (p = 0.021). The effectiveness of the first intubation equaled 84.4% in scenario A and 56.3% in scenario B (p b 0.001). The median time to intubation, measured from the moment of grasping LMA by the subject until the attempt to ventilate a patient, was 34.5 (interquartile range [IQR], 30–42.5) s in scenario A and 35 (IQR, 30.5–44) s in scenario B (p = 1.0). In this simulation study, the novice physicians were able to perform endotracheal intubation with high efficiency using LMA Fastrach as a guide for the endotracheal tube. The ongoing chest compressions did not affect the time of the intubation procedure, but significantly reduced the effectiveness of the first intubation attempt.
http://dx.doi.org/10.1016/j.ajem.2017.01.013 0735-6757/© 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Smereka J, et al, The LMA Fastrach® as a conduit for endotracheal intubation during simulated cardiopulmonary resuscitation, American Journal of Emergency Medicine (2017), http://dx.doi.org/10.1016/j.ajem.2017.01.013
2
J. Smereka et al. / American Journal of Emergency Medicine xxx (2017) xxx–xxx
References [1] Truszewski Z, Krajewski P, Fudalej M, Smereka J, Frass M, Robak O, et al. A comparison of a traditional endotracheal tube versus ETView SL in endotracheal intubation during different emergency conditions: a randomized, crossover cadaver trial. Medicine (Baltimore) 2016 Nov;95(44):e5170. [2] Szarpak L, Madziała M, Smereka J. Comparison of endotracheal intubation performed with 3 devices by paramedics wearing chemical, biological, radiological, and nuclear personal protective equipment. Am J Emerg Med 2016 Sep;34(9):1902–3. http://dx. doi.org/10.1016/j.ajem.2016.06.101. [3] Pham Q, Lentner M, Hu A. Soft palate injuries during orotracheal intubation with the videolaryngoscope. Ann Otol Rhinol Laryngol 2016 Nov 9 [pii: 0003489416678008]. [4] Baskett PJ, Parr MJ, Nolan JP. The intubating laryngeal mask. Results of a multicentre trial with experience of 500 cases. Anaesthesia 1998;53(12):1174–9. [5] Asai T, Murao K, Tsutsumi T, Shingu K. Ease of tracheal intubation through the intubating laryngeal mask during manual in-line head and neck stabilisation. Anaesthesia 2000;55(1):82–5.
[6] Abelairas-Gómez C, Barcala-Furelos R, Szarpak Ł, García-García Ó, Paz-Domínguez Á, López-García S, et al. Strength training effects on quality of prolonged basic cardiopulmonary resuscitation. Kardiol Pol 2016 Nov. 23. http://dx.doi.org/10.5603/KP.a2016. 0165. [7] Szarpak Ł, Truszewski Z, Smereka J, Czyżewski Ł. Does the use of a chest compression system in children improve the effectiveness of chest compressions? A randomised crossover simulation pilot study. Kardiol Pol 2016;74(12):1499–504. http://dx.doi. org/10.5603/KP.a2016.0107. [8] Kurowski A, Szarpak Ł, Bogdański Ł, Zaśko P, Czyżewski Ł. Comparison of the effectiveness of cardiopulmonary resuscitation with standard manual chest compressions and the use of TrueCPR and PocketCPR feedback devices. Kardiol Pol 2015;73(10): 924–30. http://dx.doi.org/10.5603/KP.a2015.0084.
Please cite this article as: Smereka J, et al, The LMA Fastrach® as a conduit for endotracheal intubation during simulated cardiopulmonary resuscitation, American Journal of Emergency Medicine (2017), http://dx.doi.org/10.1016/j.ajem.2017.01.013
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
The LMA Fastrach® as a conduit for endotracheal intubation during simulated cardiopulmonary resuscitation☆ Jacek Smereka a, Lukasz Szarpak b,⁎, Jerzy R. Ladny c a b c
Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
a r t i c l e
i n f o
Article history: Received 2 January 2017 Accepted 10 January 2017 Available online xxxx
© 2017 Elsevier Inc. All rights reserved.
Sir, Securing a clear airway is one of the priorities during CPR. Endotracheal intubation remains the gold standard for airway management [1,2]; however, when carried out by inexperienced persons, it may be associated with many complications, including teeth injury, soft tissue damage and bleeding, or edema causing inability to ventilate the patient [3]. Therefore, it is reasonable to search for alternative methods of direct laryngoscopy intubation. One of such methods is using supraglottic devices as a guide for the endotracheal tube. An example of such a device may be the laryngeal mask airway LMA Fastrach (Teleflex San Diego, San Diego, CA, USA). A number of studies point at the usefulness of the laryngeal mask in difficult airway management. Baskett et al. on the basis of a multicenter study conducted in the United Kingdom, stated that the effectiveness of the first intubation attempt with LMA equaled 80%, 4% of cases required intubation with three attempts, and 4% were failures [4]. The high efficiency of the use of LMA as a guide for the endotracheal tube refers not only to intubation in operating theaters, but also in the prehospital settings [5]. The aim of the study was to evaluate the effectiveness of intubation with the use of LMA Fastrach as a guide for endotracheal tube during simulated cardiopulmonary resuscitation. The study involved 32 novice physicians. Their median age was 25.7 (interquartile range [IQR], 25–27) years, and the median work
☆ Source of support: No sources of financial and material support to be declared. ⁎ Corresponding author at: Department of Emergency Medicine, Medical University of Warsaw, 4 Lindleya Str., 02-005, Warsaw, Poland. E-mail address: [email protected] (L. Szarpak).
experience 0.6 (IQR, 0–1) years. All participants declared their ability to perform endotracheal intubation with direct laryngoscopy. Before the study, they took part in a 10-minute training on the proper introduction of LMA and performing endotracheal intubation “blindly” with the use of LMA Fastrach as a guide for the endotracheal tube. Then the study participants had the opportunity to introduce the LMA in the training manikin. In order to simulate a patient requiring cardiopulmonary resuscitation, a MegaCode Kelly™ advanced life support manikin (Laerdal Medical, Stavanger, Norway) was used. During the study, the participants were asked to perform endotracheal intubation using LMA as a guide for the endotracheal tube. Intubation was performed in two test scenarios: (A) normal airway without chest compressions; (B) normal airway with ongoing chest compression. In order to compensate for the differences resulting from manual chest compressions [6,7,8], the chest compression system Lifeline ARM (Defibtech, USA) was applied. The order of participants and of the research scenarios was random. The study participants had a maximum of three intubation attempts in each scenario. The overall efficacy of intubation with LMA for scenario A and B was 93.7% and 84.4%, respectively (p = 0.021). The effectiveness of the first intubation equaled 84.4% in scenario A and 56.3% in scenario B (p b 0.001). The median time to intubation, measured from the moment of grasping LMA by the subject until the attempt to ventilate a patient, was 34.5 (interquartile range [IQR], 30–42.5) s in scenario A and 35 (IQR, 30.5–44) s in scenario B (p = 1.0). In this simulation study, the novice physicians were able to perform endotracheal intubation with high efficiency using LMA Fastrach as a guide for the endotracheal tube. The ongoing chest compressions did not affect the time of the intubation procedure, but significantly reduced the effectiveness of the first intubation attempt.
http://dx.doi.org/10.1016/j.ajem.2017.01.013 0735-6757/© 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Smereka J, et al, The LMA Fastrach® as a conduit for endotracheal intubation during simulated cardiopulmonary resuscitation, American Journal of Emergency Medicine (2017), http://dx.doi.org/10.1016/j.ajem.2017.01.013
2
J. Smereka et al. / American Journal of Emergency Medicine xxx (2017) xxx–xxx
References [1] Truszewski Z, Krajewski P, Fudalej M, Smereka J, Frass M, Robak O, et al. A comparison of a traditional endotracheal tube versus ETView SL in endotracheal intubation during different emergency conditions: a randomized, crossover cadaver trial. Medicine (Baltimore) 2016 Nov;95(44):e5170. [2] Szarpak L, Madziała M, Smereka J. Comparison of endotracheal intubation performed with 3 devices by paramedics wearing chemical, biological, radiological, and nuclear personal protective equipment. Am J Emerg Med 2016 Sep;34(9):1902–3. http://dx. doi.org/10.1016/j.ajem.2016.06.101. [3] Pham Q, Lentner M, Hu A. Soft palate injuries during orotracheal intubation with the videolaryngoscope. Ann Otol Rhinol Laryngol 2016 Nov 9 [pii: 0003489416678008]. [4] Baskett PJ, Parr MJ, Nolan JP. The intubating laryngeal mask. Results of a multicentre trial with experience of 500 cases. Anaesthesia 1998;53(12):1174–9. [5] Asai T, Murao K, Tsutsumi T, Shingu K. Ease of tracheal intubation through the intubating laryngeal mask during manual in-line head and neck stabilisation. Anaesthesia 2000;55(1):82–5.
[6] Abelairas-Gómez C, Barcala-Furelos R, Szarpak Ł, García-García Ó, Paz-Domínguez Á, López-García S, et al. Strength training effects on quality of prolonged basic cardiopulmonary resuscitation. Kardiol Pol 2016 Nov. 23. http://dx.doi.org/10.5603/KP.a2016. 0165. [7] Szarpak Ł, Truszewski Z, Smereka J, Czyżewski Ł. Does the use of a chest compression system in children improve the effectiveness of chest compressions? A randomised crossover simulation pilot study. Kardiol Pol 2016;74(12):1499–504. http://dx.doi. org/10.5603/KP.a2016.0107. [8] Kurowski A, Szarpak Ł, Bogdański Ł, Zaśko P, Czyżewski Ł. Comparison of the effectiveness of cardiopulmonary resuscitation with standard manual chest compressions and the use of TrueCPR and PocketCPR feedback devices. Kardiol Pol 2015;73(10): 924–30. http://dx.doi.org/10.5603/KP.a2015.0084.
Please cite this article as: Smereka J, et al, The LMA Fastrach® as a conduit for endotracheal intubation during simulated cardiopulmonary resuscitation, American Journal of Emergency Medicine (2017), http://dx.doi.org/10.1016/j.ajem.2017.01.013