Performance and skill retention of intubation by paramedics using seven different airway devices-A manikin study
Performance and skill retention of intubation by paramedics using seven different airway devices-A manikin study
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DOI：
10.1016/j.resuscitation.2011.01.008
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发表时间：
2011-05-01
期刊：
影响因子：
6.5
通讯作者：
Frass, Michael
中科院分区：
文献类型：
--
作者：
Ruetzler, Kurt;Roessler, Bernhard;Frass, Michael
导言：气管内插管(ETI)是急诊呼吸道管理中应用最广泛的方法。几项研究报告称，ETI需要相当多的技能和经验，如果操作不当，可能会导致严重的不良事件。未识别的导管错位或食道插管与较高的院前发病率有关。这项研究调查了声门上呼吸道装置的可用性与ETI的比较，以及41名先前没有经验的护理人员在使用人体模型进行培训后的技能保持情况。除袋式瓣膜通气机外，无人有过呼吸道管理经验。在持续45分钟的标准化视听讲座后，护理人员参加了使用先进的患者模拟器SimMan(R)(挪威斯塔万格的Laerdal Medical)进行的实际演示。然后，护理人员被指示使用7种不同的技术(ETI、独特喉罩[LMA]、Proseal、一次性喉管[LT-D(R)]、I-Gel(R)、Combitube(R)和EasyTube(R))按照随机顺序执行呼吸道管理。结果：在最初的训练阶段，78%的患者进行了ETI，3个月后，成功率为58%。对于声门上气道装置，6个中有5个在两个时间点都被所有护理人员成功使用，但Proseal(R)除外。我们的数据显示，6个声门上呼吸道装置中有5个在3个月后成功地保留了技能(成功率：100%)。与ETI相比，LMA、LT-D(R)和I-Gel(R)在所有时间点的通气期(T3)均显著缩短。结论：由缺乏经验的护理人员进行ETI的成功率较低。相比之下，LMA、LT-D(R)、I-Gel(R)、Combitube(R)和EasyTube(R)等声门上呼吸道设备更快速、安全和易于使用。在人体模型研究的限制范围内，这项研究表明，没有经验的医务人员可能受益于使用声门上呼吸道设备进行紧急呼吸道管理。(C)2011爱思唯尔爱尔兰有限公司。保留所有权利。
Introduction: Endotracheal intubation (ETI) is the most widespread method for emergency airway management. Several studies reported that ETI requires considerable skill and experience and if performed incorrectly, may result in serious adverse events. Unrecognized tube misplacement or oesophageal intubation is associated with high prehospital morbidity. This study investigates the usability of supraglottic airway devices compared to ETI and the skill retention of 41 previously inexperienced paramedics following training using a manikin model.Methods: 41 paramedics participated in this study. None had prior experience in airway management, apart from bag-valve ventilation. After a standardised audio-visual lecture lasting 45 min, the paramedics participated in a practical demonstration using the advanced patient simulator SimMan (R) (Laerdal Medical, Stavanger, Norway). Afterwards, paramedics were instructed to perform airway-management using seven different techniques to secure the airway (ETI, Laryngeal mask unique [LMA], Proseal, Laryngeal tube disposable [LT-D (R)], I-Gel (R), Combitube (R), and EasyTube (R)) following a randomized sequence. Participants underwent reassessment after 3 months without any further training or practice in airway-management.Results: During the initial training session, ETI was successfully performed in 78% of cases, while 3 months later the success rate was 58%. For the supraglottic airway devices, five out of six were successfully used by all paramedics at both time points, the exception being Proseal (R). Our data show successful skill retention (success rate: 100%) after 3 months for five out of six supraglottic airway devices. Time to ventilation (T3) was significantly less for LMA, LT-D (R) and I-Gel (R) at all time points compared to ETI.Conclusion: ETI performed by inexperienced paramedics is associated with a low success rate. In contrast, supraglottic airway devices like LMA, LT-D (R), I-Gel (R), Combitube (R) and EasyTube (R) are fast, safe and easy-to-use. Within the limitations of a manikin-study, this study suggests that inexperienced medical staff might benefit from using supraglottic airway devices for emergency airway management. (C) 2011 Elsevier Ireland Ltd. All rights reserved.