Traumatic out-of-hospital cardiac arrests in Melbourne, Australia

Introduction

Many consider attempted resuscitation for traumatic out-of-hospital cardiac arrest (OHCA) futile. This study aims to describe the characteristics and profile of adult traumatic OHCA.

Methods

The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify all trauma related cases of OHCA in patients aged ≥16 years.

Results

Between 2000 and 2009, EMS attended 33,178 OHCAs of which 2187 (6.6%) had a traumatic aetiology. The median age (IQR) of traumatic OHCA cases was 36 (25–55) years and 1612 were male (77.5%). Bystander CPR was performed in 201 cases (10.2%) with median (IQR) EMS response time 8 (6–11) min. The first recorded rhythm by EMS was asystole seen in 1650 (75.4%), PEA in 294 (13.4%) cases and VF in 35 cases (1.6%). Cardiac output was present in 208 (9.5%) cases who subsequently had an EMS witnessed OHCA. EMS attempted resuscitation in 545 (24.9%) patients of whom 84 (15.4%) achieved ROSC and were transported, and 27 (5.1%) survived to hospital discharge; 107 were transported with CPR of whom 8 (7.4%) survived to hospital discharge. Where EMS attempted resuscitation in traumatic OHCAs, survival for VF was 11.8% (n = 4), PEA 5.1% (n = 10) and asystole 2.4% (n = 3). In EMS witnessed traumatic OHCA, resuscitation was attempted in 175 cases (84.1%), 35 (16.8%) patients achieved sustained ROSC before transport of whom 5 (14%) survived to leave hospital and 60 (28.8%) were transported with CPR of whom 6 (10%) survived to leave hospital. Compared to OHCA cases with ‘presumed cardiac’ aetiology traumatic OHCAs were younger [median years (IQR): 36 (25–55) vs 74 (61–82)], had resuscitation attempted less (25% vs 48%), were less likely to have a shockable rhythm (1.6% vs 17.1%), were more likely to be witnessed (62.8% vs 38.1%) and were less likely to receive bystander CPR (10.2% vs 25.5%) (p < 0.001, respectively). Multivariate logistic regression identified factors associated with EMS decision to attempt resuscitation. The odds ratio [OR (95% CI)] for ‘presence of bystander CPR’ was 5.94 (4.11–8.58) and for ‘witnessed arrest’ was 2.60 (1.86–3.63).

Conclusion

In this paramedic delivered EMS attempted resuscitation was not always futile in traumatic OHCA with a survival of 5.1%. The quality of survival needs further study.     

Outcome of out-of-hospital cardiac arrests in Beijing,China

Aim

The purpose of this study was to assess the outcome of out-of-hospital cardiac arrests (OHCAs) in Beijing, China.

Methods

In this prospective study, data were collected according to the Utstein style on all cases of OHCA that occurred between January and December 2012 in urban areas covered by Beijing Emergency Medical Services (EMS). The cases were followed-up for 1 year.

Results

Out of the 9897 OHCAs recorded, cardiopulmonary resuscitation (CPR) was initiated in 2421 patients (24.4%). Among the CPR-receivers (n = 2421), 1804 patients (74.5%) had collapsed at home, while 375 patients (15.5%) at a public place. The average time interval from call to EMS arrival at the collapse location was 16 min (range, 4–43 min). Of the 1693 OHCA cases with cardiac aetiology, 1246 cases (73.6%) were witnessed, and basic CPR was performed by bystanders before arrival of the EMS personnel in 193 patients (11.4%). Of the OHCAs with cardiac aetiology, 1054 patients (62.3%) had asystole, 131 patients (7.7%) had shockable rhythms, restoration of spontaneous circulation was achieved in 85 patients (5.0%), 71 patients (4.2%) were admitted to the hospital alive, and of the 22 patients (1.3%) who were discharged alive, 17 patients (1%) had good neurological outcomes. At 1 year post-OHCA, 17 patients were alive.

Conclusion

In the urban areas of Beijing with EMS services, survival rate after OHCA was unsatisfactory. Improvements are required in every link of the ‘chain of survival’.     

Out-of-hospital airway management and cardiac arrest outcomes: a propensity score matched analysis

Objective

It is unclear whether advanced airway management during ambulance transport is associated with improved out-of-hospital cardiac arrest (OHCA) outcomes compared with bag-valve mask ventilation (BVM). This study aimed to determine whether EMT-intermediate ETI or LMA is associated with improved OHCA outcomes in Korea.

Methods

We used a Korean national OHCA cohort database composed of hospital and ambulance data. We included all EMS-treated by level 1 EMTs (EMT-intermediate level) and OHCA with presumed cardiac etiology for the period January 2006–December 2008. We excluded cases not receiving continued resuscitation in the emergency department (ED), treated by level 2 EMT, as well as those without available hospital outcome data. The primary exposure was airway management technique during ambulance transport (endotracheal tube (ETI), laryngeal mask airway (LMA) or bag-valve-mask ventilation with an oropharyngeal airway). The primary outcomes were survival to admission and survival to hospital discharge. We compared outcomes between each airway management group using multivariable logistic regression, adjusting for sex, age, witnessed, prehospital defibrillation, bystander cardiopulmonary resuscitation (CPR), call to ambulance arrival time to the scene, call to ambulance arrival time to ED, initial ECG, metropolitan (defined as population > 1 million), and level of ED (higher versus lower level). We repeated the analysis using propensity-score matched subsets.

Results

Of 54,496 patients with OHCA, we included 5278 (9.7%). Overall survival to admission and to discharge was 20.2% and 6.9%, respectively. ETI and LMA were performed in 250 (4.7%) and 391 (7.4%), respectively. In the full multivariable models using total patients, adjusted survival to admission and discharge were similar for ETI and BVM: OR 0.91 (0.66–1.27) and 1.00 (0.60–1.66), respectively. Adjusted survival to admission and discharge were significantly lower in LMA than BVM: OR 0.72 (0.54–0.95) and 0.52 (0.32–0.85), respectively. In the full multivariable models using propensity matched samples, adjusted survival to admission and discharge were similar for ETI and BVM; OR 1.32 (0.81–2.16) and 1.44 (0.66–3.15), respectively. Adjusted survival to admission was similar for LMA and BVM: OR 0.72 (0.50–1.02). However, survival to discharge was significantly lower for LMA than BVM: OR 0.45 (0.25–0.82).

Conclusions

In Korea, EMT-I placed LMA during ambulance transport was associated with worsened OHCA survival to discharge than BVM. Outcomes were similar between EMT-I endotracheal intubation and bag-valve-mask ventilation.     

喉罩麻醉联合神经阻滞麻醉与气管插管全麻在骨科手术术后的安全比较

目的 通过对LMA联合神经阻滞麻醉与气管插管全麻手术后,对患者的护理进行比较。方法 2012年1月到6月,我们选择修复重建外科复合伤、多发骨折、组织或皮肤缺损的患者50例,分为2组,对术后安全、舒适、疼痛等内容进行分析。结果 无论是安全性或者是舒适度均为喉罩组高于气道组。结论 使用LMA联合神经阻滞麻醉的患者术后优势明显高于气道组。     

Interventional strategies associated with improvements in survival for out-of-hospital cardiac arrests in Singapore over 10 years

AimWe aim to study if there has been an improvement in survival for Out-of-Hospital Cardiac Arrest (OHCA) in Singapore, the effects of various interventional strategies over the past 10 years, and identify strategies that contributed to improved survival.MethodsRates of OHCA survival were compared between 2001–2004 and 2010–2012, using nationwide data for all OHCA presenting to EMS and public hospitals. A multivariate logistic regression model for survival to discharge was constructed to identify strategies with significant impact.ResultsA total of 5453 cases were included, 2428 cases from 2001 to 2004 and 3025 cases from 2010 to 2012. There was significant improvement in Utstein (witnessed, shockable) survival to discharge from 2001–2004 (2.5%) to 2010–2012 (11.0%), adjusted odds ratio (OR) 9.6 [95% CI: 2.2–41.9]). Overall survival to discharge increased from 1.6% to 3.2% (adjusted OR 2.2 [1.5–3.3]). Bystander CPR rates increased from 19.7% to 22.4% (p = 0.02). The multivariate regression model (adjusted for important non-modifiable risk factors) showed that response time <8 min (OR 1.5 [1.0–2.3]), bystander AED (OR 5.8 [2.0–16.2]), and post-resuscitation hypothermia (OR 30.0 [11.5–78.0]) were significantly associated with survival to hospital discharge. Conversely, pre-hospital epinephrine (OR 0.6 [0.4–0.9]) was associated negatively with survival.ConclusionsOHCA survival has improved in Singapore over the past 10 years. Improvement in response time, public AEDs and post-resuscitation hypothermia appear to have contributed to the increase in survival. Singapore's experience might suggest that developing EMS systems should focus on reducing times to basic life support, including bystander defibrillation and post-resuscitation care.     

A prospective evaluation of the efficacy of the laryngeal mask airway during neonatal resuscitation

Objective

To study the feasibility, efficacy and safety of using the laryngeal mask airway (LMA) in neonatal resuscitation.

Methods

In total, 369 neonates (gestational age ≥34 weeks, expected birth weight ≥2.0 kg) requiring positive pressure ventilation at birth were quasi-randomised to resuscitation by LMA (205 neonates) or bag-mask ventilation (164 neonates).

Results

(1) Successful resuscitation rate was higher with the LMA compared with bag-mask ventilation (P < 0.001) and the total ventilation time was shorter with the LMA than with bag-mask ventilation (P < 0.001). Seven of nine neonates with an Apgar score of 2 or 3 at 1 min after birth were successfully resuscitated in the LMA group, while in the BMV group all six neonates with an Apgar score of 2 or 3 at 1 min required tracheal intubation and ventilation. In neonates with an Apgar score of 4 or 5 at 1 min after birth, successful resuscitation rate with the LMA was higher than with bag-mask ventilation (P < 0.01). (2) Successful insertion rate of the LMA at the first attempt was 98.5% and the insertion time was 7.8 s ± 2.2 s. There were few adverse events (vomiting and aspiration) in the LMA group.

Conclusion

The LMA is safe, effective and easy to implement for the resuscitation of neonates with a gestational age of 34 or, more weeks.     

A comparison of the I-gel supraglottic airway as a conduit for tracheal intubation with the intubating laryngeal mask airway: A manikin study

Background

Insertion of a supraglottic airway and tracheal intubation through it may be indicated in resuscitation scenarios where conventional laryngoscopy fails. Various supraglottic devices have been used as conduits for tracheal intubation, including the intubating laryngeal mask airway (ILMA), the Ctrach™ laryngeal mask and the I-gel supraglottic airway.

Methods

A prospective study with 25 participants evaluated the success rate of blind intubation (using a gum-elastic bougie, an Aintree intubating catheter (AIC) and designated tracheal tube) and fibrescope-guided tracheal intubation (through the intubating laryngeal mask airway and the I-gel supraglottic airway) on three different airway manikins.

Results

Twenty-five anaesthetists performed three intubations with each method on each of three manikins. The success rate of the fibrescope-guided technique was significantly higher than blind attempts (P < 0.0001) with both devices. For fibreoptic techniques, there was no difference found between the ILMA and I-gel (P > 0.05). All blind techniques were significantly more successful in the ILMA group compared to the I-gel (P < 0.0001 for bougie, Aintree catheter and tracheal tube, respectively).

Conclusions

The results of this study show that, in manikins, fibreoptic intubation through both ILMA and I-gel is a highly successful technique. Blind intubation through the I-gel showed a low success rate and should not be attempted.     

纤支镜、喉罩联合运用成功处理困难气道1例

本文报道纤支镜、喉罩联合运用成功处理困难气道1例的经过及体会. 1 病例资料     

Epinephrine in out-of-hospital cardiac arrest: A critical review

BACKGROUND:

Epinephrine is recommended in advanced cardiac life support guidelines for use in adult cardiac arrest, and has been used in cardiopulmonary resuscitation since 1896. Yet, despite its long time use and incorporation into guidelines, epinephrine suffers from a paucity of evidence regarding its influence on survival. This critical review was conducted to address the knowledge deficit regarding epinephrine in out-of-hospital cardiac arrest and its effect on return of spontaneous circulation, survival to hospital discharge, and neurological performance.

METHODS:

The EMBASE and MEDLINE (through the Pubmed interface) databases, and the Cochrane library were searched with the key words “epinephrine”, “cardiac arrest” and variations of these terms. Original research studies concerning epinephrine use in adult, out-of-hospital cardiac arrest were selected for further review.

RESULTS:

The search yielded nine eligible studies based on inclusion criteria. This includes five prospective cohort studies, one retrospective cohort study, one survival analysis, one case control study, and one RCT. The evidence clearly establishes an association between epinephrine and increased return of spontaneous circulation, the data were conflicting concerning survival to hospital discharge and neurological outcome.

CONCLUSIONS:

The results of this review exhibit the paucity of evidence regarding the use of epinephrine in out of hospital cardiac arrest. There is currently insufficient evidence to support or reject its administration during resuscitation. Larger sample, placebo controlled, double blind, randomized control trials need to be performed to definitively establish the effect of epinephrine on both survival to hospital discharge and the neurological outcomes of treated patients.KEY WORDS: Emergency medicine, Epinephrine, Cardiac arrest, Prehospital, Out-of-hospital, Resuscitation     

Out-of-hospital airway management by paramedics and emergency physicians using laryngeal tubes

Concept

Endotracheal intubation (ETI) is considered to be the gold standard of prehospital airway management. However, ETI requires substantial technical skills and ongoing experience. Because failed prehospital ETI is common and associated with a higher mortality, reliable airway devices are needed to be used by rescuers less experienced in ETI. We prospectively evaluated the feasibility of laryngeal tubes used by paramedics and emergency physicians for out-of-hospital airway management.

Material and methods

During a 24-month period, all cases of prehospital use of the laryngeal tube disposable (LT-D) and laryngeal tube suction disposable (LTS-D) within five operational areas of emergency medical services were recorded by a standardised questionnaire. We determined indications for laryngeal tube use, placement success, number of placement attempts, placement time and personal level of experience.

Results

Of 157 prehospital intubation attempts with the LT-D/LTS-D, 152 (96.8%) were successfully performed by paramedics (n = 70) or emergency physicians (n = 87). The device was used as initial airway (n = 87) or rescue device after failed ETI (n = 70). The placement time was ≤45 s (n = 120), 46-90 s (n = 20) and >90 s (n = 7). In five cases the time needed was not specified. The number of placement attempts was one (n = 123), two (n = 25), three (n = 2) and more than three (n = 2). The majority of users (61.1%) were relative novices with no more than five previous laryngeal tube placements.

Conclusion

The LT-D/LTS-D represents a reliable tool for prehospital airway management in the hands of both paramedics and emergency physicians. It can be used as an initial tool to secure the airway until ETI is prepared, as a definitive airway by rescuers less experienced with ETI or as a rescue device when ETI has failed.     

A new tracheal tube and methods to facilitate ventilation and placement in emergency airway management

The “jet endotracheal tube” (JET) has been designed to facilitate emergency intubation in apnoeic or paralyzed patients with a difficult airway. We investigated the efficiency of jet ventilation to maintain adequate oxygenation and ventilation using the initially designed JET, either with its distal tip positioned above vocal cord and pointed directly at or 45° to the right of the vocal cord opening midline in 10 adult paralyzed pigs. The effectiveness of using end tidal carbon dioxide pressure (PetCO₂), chest rise and breath sounds to facilitate tracheal placement of the JET blindly in a simulated difficult airway was studied. All complications of using the JET were noted. Jet ventilation with the distal tip of the JET pointed directly at, not 45° to the right of vocal cord opening midline, provides adequate oxygenation and ventilation during intubation. In a simulated difficult airway, PetCO₂, chest rise and breath sounds were all effective methods to assist placement of the JET blindly, and the combination of all three methods works the best. No serious complications were detected with the use of the JET. Our results suggest that a correctly positioned JET guided by monitoring PetCO₂, chest rise and breath sound provides adequate oxygenation and ventilation during intubation in apnoeic pigs, and facilitates the intubation blindly in a simulated difficult airway. No serious complications were observed using the JET in this study. In patients requiring emergency intubation, a JET with PetCO₂ monitoring catheter and the instructions for use may be a useful addition to the airway management devices.     

Lingual nerve injury caused by laryngeal mask airway during percutaneous nephrolithotomy: A case report

BACKGROUNDLingual nerve injury (LNI) is a rare complication following the use of laryngeal mask airway (LMA). The occurrence of this unexpected complication causes uncomfortable symptoms in patients and worsens their quality of life. We present an unusual case of LNI caused by the use of an LMA in percutaneous nephrolithotomy (PCNL).CASE SUMMARYA 49-year-old man presented to our hospital with a 3-year history of intermittent left lower back pain. Abdominal computed tomography showed a 25 mm × 20 mm stone in the left renal pelvis. PCNL surgery using LMA was performed to remove the renal stone. The patient reported numbness on the tip of his tongue after the operation, but there were no signs of swelling or trauma. The patient was diagnosed with LNI after other possible causes were ruled out. The symptom of numbness eventually improved after conservative medical therapy for 1 wk. The patient completely recovered 3 wk after surgery.CONCLUSIONThis is the first case report describing LNI with the use of LMA in PCNL. In our case, an inappropriate LMA size, intraoperative movement, and a specific surgical position might be potential causes of this rare complication.     

Analysis of out-of-hospital cardiac arrest location and public access defibrillator placement in Metropolitan Phoenix,Arizona

ObjectivesAutomated external defibrillators (AEDs) improve outcomes from out-of-hospital cardiac arrest (OHCA) but are infrequently used. We sought to compare the locations of OHCAs and AEDs in metropolitan Phoenix, Arizona.MethodsPublic location OHCAs and AEDs were geocoded utilizing a statewide OHCA database (1/2010–12/2012) and AED registry. OHCAs were mapped using kernel-density estimation and overlapped with AED placements. Spearman's rho was obtained to determine the correlation between OHCA incidents and AED locations.ResultsA total of 654 consecutive public location OHCAs and all 1704 non-medical facility AEDs registered in the study area were included in the analysis. High OHCA incident areas lacking AEDs were identified in the kernel-density surface map. OHCA event/AED correlation analysis showed a weak correlation (Spearman's rho = 0.283; p = 0.002). Events occurred most frequently at locations categorized as “In Cars/Roads/Parking lots” (190/654, 29.1%) and there were no identified AEDs for these areas. AEDs were placed most frequently in “Public business/Office/Workplace” and cardiac arrests occurred with the second highest frequency in this location type.ConclusionThere was a weak correlation between OHCA events and deployed AEDs. It was possible to identify areas where OHCAs occurred frequently but AEDs were lacking. The ability to correlate the sites of OHCAs and AED locations is a necessary step toward improving the effectiveness of public access defibrillation.     

Successful management of a neonate with Pierre-Robin syndrome and severe upper airway obstruction by long term placement of a laryngeal mask airway

The severity of airway obstruction varies in infants with Pierre-Robin syndrome (PRS). Some have severe upper airway obstruction that results in respiratory failure and even death. We report a case of neonate with isolated PRS who had a severe airway obstruction and respiratory failure after birth. She had complications of bilateral pneumothorax, subcutaneous emphysema, and hypoxaemia due to difficult tracheal intubation. Respiratory failure recurred immediately after extubation; she was resuscitated by inserting a laryngeal mask airway. The laryngeal mask airway was left inserted for 6 days. It was successful in this patient and eliminated the need for invasive surgical procedures. In conclusion, the relatively long term use of a laryngeal mask airway, which has not been reported before, could be an alternative therapy for patients with PRS with airway obstruction.     

Survival after out-of-hospital cardiac arrest in relation to sex: A nationwide registry-based study

Aim

Crude survival has increased following an out-of-hospital cardiac arrest (OHCA). We aimed to study sex-related differences in patient characteristics and survival during a 10-year study period.

Methods

Patients ≥12 years old with OHCA of a presumed cardiac cause, and in whom resuscitation was attempted, were identified through the Danish Cardiac Arrest Registry 2001–2010. A total of 19,372 patients were included.

Results

One-third were female, with a median age of 75 years (IQR 65–83). Compared to females, males were five years younger; and less likely to have severe comorbidities, e.g., chronic obstructive pulmonary disease (12.8% vs. 16.5%); but more likely to have arrest outside of the home (29.4% vs. 18.7%), receive bystander CPR (32.9% vs. 25.9%), and have a shockable rhythm (32.6% vs. 17.2%), all p < 0.001. Thirty-day crude survival increased in males (3.0% in 2001 to 12.9% in 2010); and in females (4.8% in 2001 to 6.7% in 2010), p < 0.001.Multivariable logistic regression analyses adjusted for patient characteristics including comorbidities, showed no survival difference between sexes in patients with a non-shockable rhythm (OR 1.00; CI 0.72–1.40), while female sex was positively associated with survival in patients with a shockable rhythm (OR 1.31; CI 1.07–1.59). Analyses were rhythm-stratified due to interaction between sex and heart rhythm; there was no interaction between sex and calendar-year.

Conclusions

Temporal increase in crude survival was more marked in males due to poorer prognostic characteristics in females with a lower proportion of shockable rhythm. In an adjusted model, female sex was positively associated with survival in patients with a shockable rhythm.     

Higher insertion success with the i-gel supraglottic airway in out-of-hospital cardiac arrest: A randomised controlled trial

Background

Since their emergence from the operating theatre over a decade ago, supra-glottic airways (SGA) have become increasingly common in the management of out-of-hospital cardiac arrest (OOHCA) with laryngeal masks (LM) the most common SGA. The proliferation of LMs in the prehospital setting has occurred despite lower than expected rates of successful insertion being reported.

Methods

We conducted a single-centre, prospective parallel-group, ‘open label’ randomised controlled trial in subjects with OOHCA (aged greater than or equal to 12 years of age; weighing greater than or equal to 30 kg) were allocated to either the i-gel^® supraglottic airway (IG-SGA) or the Portex^® Soft Seal^® Laryngeal Mask (PSS-LM) within a large Australian ambulance service. Our hypothesis was that use of the IG-SGA, when compared to the Portex^® PSS-LM, would result in a higher rate of successful insertion in patients presenting with OOHCA. The primary outcome was successful insertion of the SGA.

Main findings

There were 51 patients randomised. Subjects had an average age of 65 years and 40% were female. There were no apparent differences in key demographic characteristics between groups. The IG-SGA had a significantly higher success rate than the PSS-LM (90% versus 57%; p = 0.023), resulting in a 58% greater likelihood of successful insertion than the PSS-LM (RR 1.58; 95% CI 1.11–2.24). The IG-SGA was associated with significantly lower median “ease of insertion” scores.

Conclusion

The i-gel^® supraglottic airway was associated with higher successful insertion rates in subjects with out-of-hospital cardiac arrest.     

Cognitive impairments in survivors of out-of-hospital cardiac arrest: A systematic review

Objective

To describe the current evidence on the frequency and nature of cognitive impairments in survivors of out-of-hospital cardiac arrest.

Design

Systematic review.

Data sources

Pubmed, Embase, PsychInfo and Cinahl (1980–2006). No language restriction was imposed.

Review methods

The following inclusion criteria were used: participants had to be survivors of out-of-hospital cardiac arrest, 18 years or older, and there had to be least one cognitive outcome measure with a follow-up of 3 months or more. Case reports and qualitative studies were excluded. The articles were screened on title, abstract and full text by two reviewers. All selected articles were reviewed and assessed by two reviewers independently using a quality criteria list.

Results

Out of the 286 articles initially identified, 28 were selected for final evaluation. There was a high heterogeneity between the studies with regard to study design, number of participants, outcome measures and duration of follow-up. In general, the quality of the articles appeared low, with a few positive exceptions.The reported frequency of cognitive impairments in survivors of out-of-hospital cardiac arrest ranged from 6% to 100%. Memory problems were the most common cognitive impairment, followed by impairments in attention and executive functioning. Three high-quality prospective studies found that cognitive problems occurred in about half of the survivors of out-of-hospital cardiac arrest.

Conclusion

There are few good studies on the frequency of cognitive impairments after out-of-hospital cardiac arrest. However, cognitive problems, in particular memory problems, seem common in survivors of out-of-hospital cardiac arrest.     

超声引导颈内静脉穿刺置管术在I-gel喉罩通气时的应用

目的探讨喉罩通气时行颈内静脉穿刺置管时超声引导法与传统体表标志定位方法的差异。方法将40例全身麻醉置入I-gel喉罩通气拟行平卧位腹部手术的成年患者随机分为超声引导组(U组,20例)与传统体表标志定位方法组(C组,20例),U组在超声实时引导下行颈内静脉置管术,C组使用传统的体表标志定位法行颈内静脉置管术。两组穿刺点均选择甲状软骨水平入路。记录U组患者喉罩置入前后甲状软骨水平颈内静脉与颈总动脉各自中心点的体表投射点与正中线间距离等变化。记录两组首次穿刺成功率、试穿次数、总成功率、穿刺时间及并发症情况。结果 U组患者喉罩置入前后颈内静脉与颈总动脉各自中心点与正中线距离均明显增加(P0.01),颈内静脉内径、两者间水平距离、两者水平重叠率差异有统计学意义(P0.01)。两组首次穿刺成功率、试穿次数、总成功率、穿刺时间及并发症差异均有统计学意义(P0.01)。结论 I-gel喉罩置入会导致颈部血管外移,右颈内静脉内径及其与颈总动脉的水平距离及重叠率显著变化,不利于颈内静脉穿刺置管;喉罩通气中颈内静脉穿刺置管时超声引导法相对于传统体表标志定位方法可明显提高穿刺成功率。     

Preliminary case series report: use of the laryngeal mask airway Fastrach oral endotracheal tube with the Bullard laryngoscope

Use of the Bullard laryngoscope has been fraught with difficulties, especially for inexperienced users who often end up placing the instrument on the back shelf of the airway cart without further use. A recent hypothesis suggests that the use of a flexible tip tube on the Bullard stylet might facilitate intubation. Initially, the Fastrach laryngeal mask airway (LMA North America, Inc, San Diego, California) flexible tip endotracheal tube was loaded on the Bullard laryngoscope stylet (Circon ACMI, Stamford, Connecticut) and used for intubation. The ease of intubation was noteworthy. Intubations on 6 patients assessed as difficult to intubate were performed on the first attempt without any difficulty. In fact, the effortlessness of these potentially difficult intubations led to the conclusion that the preliminary finding should be reported immediately.     

King LT-D use by urban basic life support first responders as the primary airway device for out-of-hospital cardiac arrest

Objective

The objective of this study was to compare the frequency of first attempt success between basic life support (BLS) first responder initiated King LT-D placement and paramedic initiated endotracheal intubation (ETI) among patients experiencing out-of-hospital cardiac arrest (OOHCA).

Methods

In 2009 a large, urban EMS agency modified their out-of-hospital, non-traumatic, cardiac arrest protocol from paramedic initiated ETI to first responder initiated King LT-D placement. This retrospective analysis of all adult, non-traumatic cardiac arrests occurred four months before and four months after protocol implementation. The outcome variable in this analysis was first attempt airway management success defined as placement of the device with end tidal CO₂ wave form or colorimetric color change, auscultation of bilateral breath sounds, and improved or normal pulse oximetry reading. The independent variable of interest was initial device utilized to secure the airway, King LT-D or ETI.

Results

There were 351 adult, non-traumatic OOHCAs with 184 patients (52.4%) enrolled during the ETI period and 167 (47.6%) during the King LT-D period. The frequency of first attempt success was 57.6% in the ETI group and 87.8% in the King LT-D group. Patients in the King LT-D group were significantly more likely to experience first attempt success versus standard ETI methods (OR 5.3; 95%CI 2.9-9.5).

Conclusion

In this analysis of OOHCA airway management, first attempt BLS King LT-D placement success exceeded that of first attempt paramedic ETI success. In addition, patients in the King LT-D group were more likely to have had an advanced airway attempted and to have had a successful advanced airway placed when multiple attempts were required.