Showing papers on "Combitube published in 2010"

Advanced Airway Management Does Not Improve Outcome of Out-of-hospital Cardiac Arrest

Abstract: Background: The goal of out-of-hospital endotracheal intubation (ETI) is to reduce mortality and morbidity for patients with airway and ventilatory compromise. Yet several studies, mostly involving trauma patients, have demonstrated similar or worse neurologic outcomes and survival-to-hospital discharge rates after out-of-hospital ETI. To date, there is no study comparing out-of-hospital ETI to bag-valve-mask (BVM) ventilation for the outcome of survival to hospital discharge among nontraumatic adult out-of-hospital cardiac arrest (OOHCA) patients. Objectives: The objective was to compare survival to hospital discharge among adult OOHCA patients receiving ETI to those managed with BVM. Methods: In this retrospective cohort study, the records of all OOHCA patients presenting to a municipal teaching hospital from November 1, 1994, through June 30, 2008, were reviewed. The type of field airway provided, age, sex, race, rhythm on paramedic arrival, presence of bystander cardiopulmonary resuscitation (CPR), whether the arrest was witnessed, site of arrest, return of spontaneous circulation (ROSC), survival to hospital admission, comorbid illnesses, and survival to hospital discharge were noted. A univariate odds ratio (OR) was first computed to describe the association between the type of airway and survival to hospital discharge. A multivariable logistic regression analysis was performed, adjusting for rhythm, bystander CPR, and whether the arrest was witnessed. Results: A cohort of 1,294 arrests was evaluated. A total of 1,027 (79.4%) received ETI, while 131 (10.1%) had BVM, 131 (10.1%) had either a Combitube or an esophageal obturator airway, and five (0.4%) had incomplete prehospital records. Fifty-five of 1,294 (4.3%) survived to hospital discharge; there were no survivors in the Combitube ⁄esophageal obturator airway cohort. Even after multivariable adjustment for age, sex, site of arrest, bystander CPR, witnessed arrest, and rhythm on paramedic arrival, the OR for survival to hospital discharge for BVM versus ETI was 4.5 (95% confidence interval [CI] = 2.3‐8.9; p<0.0001). Conclusions: In this cohort, when compared to BVM ventilation, advanced airway methods were associated with decreased survival to hospital discharge among adult nontraumatic OOHCA patients. ACADEMIC EMERGENCY MEDICINE 2010; 17:926‐931 a 2010 by the Society for Academic Emergency

Use of the King LT for emergency airway management.

Abstract: Objective To discuss the role of the King LT reusable supraglottic airway in emergency airway management. Design Retrospective case series review. Setting Tertiary academic medical facility. Patients We studied patients who presented to the emergency trauma center having undergone intubation at an outside facility or at the scene of the incident. The otolaryngology service was consulted for definitive management of the airway. Main Outcome Measure Airway evaluation and management once the King LT has been placed. Results Six patients with known prehospitalization use of the King LT presented to the emergency trauma center and subsequently required emergency tracheostomy for establishment of a secure airway. Fiberoptic and/or direct laryngoscopic evaluation performed with the tube in place failed to reveal whether safe oral endotracheal intubation could be performed because of visualization problems. Examination after tracheostomy and removal of the King LT revealed that in 2 patients, orotracheal intubation would have been difficult or impossible, whereas another 4 patients could have been intubated. One patient had prehospitalization placement of a King LT, which resulted in subcutaneous emphysema because of placement within the mediastinum. The patient was able to be successfully intubated and did not require tracheostomy. Conclusions The King LT offers benefits in emergency situations, but evaluation of the airway is challenging and often necessitates tracheostomy for establishment of a safe and secure airway. Even if tracheostomy is not required, serious complications may occur.

Core Topics in Airway Management: Facemasks and supraglottic airway devices

Abstract: Hypoxaemic hypoxia (airway obstruction) is more damaging to cells than anaemic or stagnant hypoxia. In order to fully understand the classification of hypoxia, it is useful to consider the example of carbon monoxide poisoning. It is known that hypoxaemic hypoxia is of particular importance in the development of cellular hypoxia and it goes without saying that, in the context of the difficult airway, the principal cause of hypoxaemia is airway obstruction. It is important to understand the mechanisms by which hypoxaemia develops, and the factors which determine the rate of this process. Causes of hypoxaemia occurring during anaesthesia can be divided into the following three categories: problems with O2 supply, problems with O2 delivery from lips to lung, and problems with O2 transfer from lung to blood. Pre-oxygenation aims to increase body O2 stores to their maximum, so that periods of apnoea are tolerated for longer before critical desaturation occurs.

Keeping patent airways.

Abstract: Even in the hospital environment or outside it, to maintain the patency of the airway has an important role in the critically ill patient. Appropriate initial assessment using the LHF (look, hear, feel) will determine clinically if there is a lack of permeability of the airway or assisted ventilation need. If there is not patency of the airway, do perform the maneuver of the head tilt / chin lift, as long as there is no suspicion of cervical injury, in which case you can make the jaw thrust. If the patient requires manual ventilation after performing the maneuver of chin lift or jaw thrust, the bag-valve-mask device can be used, which is much more efficiently performed with two operators. Endotracheal intubation remains the most effective measure to ensure a patent airway, but it takes experience to perform the procedure. An easy alternative is the placement of a laryngeal mask or “combitube” in a “blind” manner; which is without direct observation of the glottis.