Exclusives
FacebookTwitterLinkedInGoogle+RSS Feed
Fire EMSEMS TodayEMS Insider

Restricted Access to Patent Airway

DSC-0250-jmacie

Review of: Hoyle JD, Jones JS, Deibel M, et al: Comparative study of airway management techniques with restricted access to patient airway. Prehospital Emergency Care. 11(3):330-336, 2007.

The Science

This study conducted by the Grand Rapids Medical Education and Research Center examines the number of attempts required and the time to successfully ventilate a mannequin placed in non-traditional scenarios. They compared the endotracheal tube (ET), Combitube (CT) and the Laryngeal Mask Airway (LMA). They also compared the times and success rates of 25 emergency medicine residents, nine emergency medicine faculty and 22 paramedics.

The mannequins were placed in one of three positions: 1) supine under a table with the head abutting a table and a table overlying them, 2) sitting upright with access only from behind, and 3) lying on its side with access only by lying on the floor facing it. The supine and side scenarios simulated a confined-space rescue, and the access from behind simulated a trapped-vehicle patient.

They found no significant difference between residents, faculty and paramedics in the number of attempts needed to successfully ventilate the mannequin. EMT-Ps demonstrated significantly faster times to successful ventilation for all scenarios versus physicians except for the mannequin lying on its side, for which no significant difference was noted. Specifically, in the supine scenario with ET, the EMT-P median time was 57 seconds, whereas the physician median time was 96 seconds. The time to ventilation for all scenarios was less with the LMA versus ET, or CT versus ET, except in the sitting scenario where ET and CT were comparable

They concluded, In this mannequin model of restricted airway access, LMA resulted in significantly faster times to ventilation versus ET and CT in all but one scenario.

The Street

Finally! We re starting to realize that intubation in the prehospital setting requires a unique knowledge and skill set. Despite having less experience with both ET and LMA, the paramedics were able to ventilate the patient in less time than the doctors. Perhaps this is, as the authors noted, a reflection of the fact that paramedics often have little help in the field and must be confident in dealing with such life-threatening scenarios on their own.

This further reinforces my belief that, just like the military, train like you fight and you will fight like you train. Prehospital intubation is never like the sterile environment of the OR, and we should support training and educating our providers to deal with real life scenarios.

Clearly, the role of non-visualized airways is highlighted by this study. Although debate continues over which is the most appropriate device, this study shows that the LMA is more efficient. It will be interesting to see similar studies comparing these devices with the King LT and Cobra.

RELATED ARTICLES

Where in the World of EMS is A.J. Heightman?

You cant get there from here.

Reflecting on 35 Years of Innovation in JEMS

Take a walk through the last 35 years of EMS in JEMS.

Pro Bono: Documenting Patient Refusals

Obtaining a signature is only the start of accepting refusal.

The Reasons Why EMS Systems Go Astray

Normalization of deviance doesn’t happen overnight.

Thorough Assessment is Crucial in Patients with Respiratory Distress

Accurate observation and treatment go a long way when considering all causes of respiratory distress.

Training, Practice, Research Lead to Successful Airway Management

Knowing how to correctly intubate a patient is only half the battle.

Features by Topic

JEMS Connect

CURRENT DISCUSSIONS

 
 

EMS BLOGS

Blogger Browser

Today's Featured Posts

Featured Careers