Cluster cross-over randomised trial of paediatric airway management devices in the simulation lab and operating room among paramedic students.
Cluster cross-over randomised trial of paediatric airway management devices in the simulation lab and operating room among paramedic students.
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DOI：
10.1136/emermed-2020-209929
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Kato M
中科院分区：
文献类型：
--
作者：
Hansen ML;Wagner A;Schnapp A;Lin A;Le N;Deverman S;Pedigo E;Johnson A;Cusick J;Gries H;Kato M
本研究的目的是比较模拟实验室和手术室环境中的儿科急诊气道管理策略。这是一项两部分分组交叉随机试验，包括2017年1月至2018年6月在美国俄勒冈州波特兰进行的模拟实验室和手术室环境。在模拟婴儿心脏骤停中，护理人员学生以随机顺序放置气管内导管、i-gel®或喉罩气道。在手术室中，护理学生将喉罩气道或i-gel®设备以随机顺序放置在连续患者中。研究两个部分的主要结局是通气时间。在手术室部分，我们还评估了泄漏压力和平均初始潮气量。有58名护理专业学生参加了模拟实验室，22名参加了手术室研究。在模拟实验室中，i-gel®的平均气道放置时间为48.5秒，喉罩为68.9秒，气管插管为129.5秒。在手术室中，放置i-gel®的平均时间为34.3秒，喉罩为45.2秒。在模拟研究的多变量分析中，喉罩和i-gel®明显快于气管插管，i-gel®快于喉罩。在手术室中，i-gel®喉罩和喉罩之间的放置时间、泄漏压力和前5次呼吸的平均通气量没有显著差异。我们发现，护理专业的学生能够在模拟实验室和手术室环境中快速放置声门上设备，成功率很高。声门上器械，尤其是i-gel，被评定为易于使用。i-gel可能是最容易使用的，因为它没有可充气的袖带，并且需要更少的步骤来放置。
The objective of this study was to compare pediatric emergency airway management strategies in the simulation lab and operating room environments. This was a two-part cluster crossover randomized trial including simulation lab and operating room environments conducted between January 2017 and June 2018 in Portland, Oregon, USA. In simulated infant cardiac arrests, paramedic students placed an endotracheal tube, an i-gel®, or a laryngeal mask airway in random order. In the operating room, paramedic students placed a laryngeal mask airway or i-gel® device in random order in sequential patients. The primary outcome for both portions of the study was time to ventilation. In the operating room portion, we also evaluated leak pressures and average initial tidal volumes. There were 58 paramedic students who participated in the simulation lab and 22 who participated in the operating room study. The mean time to airway placement in the simulation lab was 48.5 seconds for the i-gel®, 68.9 seconds for the laryngeal mask, and 129.5 seconds for the endotracheal tube. In the operating room, mean time to i-gel® placement was 34.3 seconds with 45.2 seconds for the laryngeal mask. In multivariable analysis of the simulation study, the laryngeal mask and i-gel® were significantly faster than the endotracheal tube, and the i-gel® was faster than the laryngeal mask. In the operating room, there was no significant difference in time to placement, leak pressure, and average volume of the first 5 breaths between the i-gel® and laryngeal mask. We found that paramedic students were able to place supraglottic devices rapidly with high success rates in simulation lab and operating room environments. Supraglottic devices, particularly the i-gel, were rated as easy to use. The i-gel may be easiest to use since it lacks an inflable cuff and requires fewer steps to place.
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