急诊医生在院外心肺复苏期间使用可弯曲光棒引导经气管插管喉罩进行气管插管的可行性。

Feasibility of flexible lightwand-guided tracheal intubation with the intubating laryngeal mask during out-of-hospital cardiopulmonary resuscitation by an emergency physician.

作者信息

Dimitriou V, Voyagis G S, Grosomanidis V, Brimacombe J

机构信息

General Hospital of Athens, Greece.

出版信息

Eur J Anaesthesiol. 2006 Jan;23(1):76-9. doi: 10.1017/S026502150500181X.

DOI:10.1017/S026502150500181X

PMID:16390571

Abstract

BACKGROUND AND OBJECTIVE

We tested the feasibility of using the intubating laryngeal mask airway Fastrach (ILMA) as a ventilatory device and for flexible lightwand-guided tracheal intubation for out-of-hospital cardiopulmonary resuscitation by an emergency physician.

METHODS

After completion of a training programme, a single experienced emergency physician used the technique for all patients requiring out-of-hospital tracheal intubation over a 10-month period. If access to the head and neck was limited, the intubating laryngeal mask airway was inserted from below and to the side, otherwise it was inserted from above the head. Data about the time for the ambulance to reach the patient, whether or not access to the head and neck was limited, whether or not circulation was successfully restored, and the insertion and intubation success rates were noted.

RESULTS

The mean (range) time for the ambulance to reach the patient was 12 (10-20) min. Access to the head and neck was limited in 8/37 (22%). Circulation was successfully restored in 10/37 (27%). The intubating laryngeal mask airway was successfully inserted at the first attempt in 35/37 (95%) and at the second attempt in 2/37 (5%). The tracheal tube was successfully inserted in 25/37 (67.5%) at the first attempt, 7/37 (19%) at the second attempt and 5/37 (13.5%) at the third attempt. There were no overall failures for intubating laryngeal mask airway insertion or tracheal intubation. There were no differences in success rate between positions. Oesophageal intubation was detected and corrected in 2/37 (5%).

CONCLUSION

The intubating laryngeal mask airway has a high success rate as a ventilatory device and as a flexible lightwand-guided airway intubator during out-of-hospital cardiopulmonary resuscitation by a well-trained emergency physician. This technique may be particularly useful when there is limited access to the head and neck.

摘要

背景与目的

我们测试了使用插管喉罩气道Fastrach（ILMA）作为通气设备以及在院外心肺复苏中由急诊医生进行弹性光棒引导气管插管的可行性。

方法

在完成一项培训计划后，一名经验丰富的急诊医生在10个月的时间里对所有需要院外气管插管的患者使用该技术。如果头颈部的操作空间受限，插管喉罩气道从下方和侧面插入，否则从头部上方插入。记录救护车到达患者的时间、头颈部操作空间是否受限、循环是否成功恢复以及插入和插管成功率的数据。

结果

救护车到达患者的平均（范围）时间为12（10 - 20）分钟。37例中有8例（22%）头颈部操作空间受限。37例中有10例（27%）循环成功恢复。插管喉罩气道首次尝试成功插入的有35/37（95%），第二次尝试成功插入的有2/37（5%）。气管导管首次尝试成功插入的有25/37（67.5%），第二次尝试成功插入的有7/37（19%），第三次尝试成功插入的有5/37（13.5%）。插管喉罩气道插入或气管插管均未出现总体失败情况。不同插入位置的成功率无差异。37例中有2例（5%）检测并纠正了食管插管情况。