Chen Lei, Hsiao Allen L
Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut 06504, USA.
Pediatrics. 2008 Aug;122(2):e294-7. doi: 10.1542/peds.2008-0103. Epub 2008 Jul 21.
Proficiency in airway management in children is difficult to acquire and maintain for prehospital providers. The laryngeal mask airway is a relatively new airway device. Its ease of use makes it an attractive potential alternative to endotracheal tubes in pediatrics. The objective of this study was to investigate whether, in simulated cardiopulmonary arrests in children, the use of laryngeal mask airway, compared with endotracheal tubes, results in shorter time to effective ventilation when performed by prehospital providers.
A randomized, crossover study was conducted in a local paramedic training program. Fifty-two emergency medical technicians agreed to participate. After a 2-hour training session, an arrest scenario was presented to each participant by using an infant-sized human patient simulator. The participants were randomly assigned first to use 1 of the 2 devices. Time to successful ventilation was recorded. Number of attempts and results were recorded. After the airway was secured successfully, the scenario was repeated with the alternative device.
The mean +/- SD length of time to effective ventilation was 46 seconds when using endotracheal tubes and 23 seconds when using laryngeal mask airway, with a mean difference of 23 seconds. The mean number of attempts to achieve effective ventilation was 1.27 when using endotracheal tubes and 1.1 when using laryngeal mask airway. There were 9 (17%) episodes of esophageal intubations and 14 (27%) episodes of right main-stem intubations in the endotracheal tube group, and there were 5 (9.5%) episodes of malposition in the laryngeal mask airway group.
In simulated pediatric arrests, the use of laryngeal mask airway, compared with endotracheal tubes, led to more rapid establishment of effective ventilation and fewer complications when performed by prehospital providers.
对于院前急救人员而言，熟练掌握儿童气道管理技术并非易事，且难以持续保持。喉罩气道是一种相对较新的气道装置。其使用简便，使其成为儿科气管插管颇具吸引力的潜在替代方案。本研究的目的是调查在儿童模拟心肺骤停时，与气管插管相比，院前急救人员使用喉罩气道进行通气时，达到有效通气的时间是否更短。
在当地的护理人员培训项目中进行了一项随机交叉研究。52名急救医疗技术人员同意参与。经过2小时的培训课程后，使用婴儿尺寸的人体患者模拟器向每位参与者展示一个骤停场景。参与者首先被随机分配使用两种装置中的一种。记录成功通气的时间。记录尝试次数和结果。在气道成功固定后，使用另一种装置重复该场景。
使用气管插管时，有效通气的平均时间（±标准差）为46秒，使用喉罩气道时为23秒，平均差异为23秒。使用气管插管时实现有效通气的平均尝试次数为1.27次，使用喉罩气道时为1.1次。气管插管组有9例（17%）发生食管插管，14例（27%）发生右主支气管插管，喉罩气道组有5例（9.5%）发生位置不当。
在模拟的儿科骤停中，与气管插管相比，院前急救人员使用喉罩气道能更快地建立有效通气，且并发症更少。
