Shackleton Department of Anaesthetics, Southampton University Hospital NHS Trust, Tremona Road, Southampton SO16 6YD, UK.
Resuscitation. 2010 May;81(5):539-43. doi: 10.1016/j.resuscitation.2010.02.001. Epub 2010 Mar 1.
Traditionally, anaesthetists have provided airway management skills on resuscitation teams. Because advanced life support (ALS) courses teach practical airway management, some UK hospitals have dropped anaesthetists from cardiac arrest teams. Does the ALS course give non-anaesthetists adequate skills to manage an airway during a cardiac arrest?
We recruited adult surgical patients undergoing general anaesthesia and laryngeal mask airway (LMA) insertion as part of their routine care. Patients were randomly assigned to airway management by a junior doctor; either an ALS-qualified anaesthetist or an ALS-qualified non-anaesthetist. After induction of anaesthesia, five manual ventilations were delivered using a self-inflating bag-mask device before insertion of a LMA. We recorded the quality of manual ventilation (adequate, partially adequate or inadequate), the time to LMA insertion, and any complications.
Twenty anaesthetists and 16 non-anaesthetist ALS graduates participated. Of the anaesthetists, 18 (90%) demonstrated adequate and 2 (10%) demonstrated partially adequate manual ventilation skills, compared with non-anaesthetists of whom 5 (31.25%) demonstrated adequate, 5 (31.25%) demonstrated partially adequate, and 6 (37.5%) demonstrated inadequate manual ventilation skills (p<0.001). Eighteen anaesthetists (90%) and 4 non-anaesthetists (25%) met the ALS LMA insertion guideline time of 30s (p<0.0001). Median time for LMA insertion by anaesthetists and non-anaesthetists was 20.5s (range 16-40s, n=20) and 35.0 s (range 18-168, n=10) respectively (p<0.05). Six of the 16 non-anaesthetists failed to insert the LMA (37.5%). There were four complications (laryngospasm, vomiting, and SaO(2)<90%) in the non-anaesthetic group (25% of patients), compared with none in the anaesthetic group (p=0.01).
The airway component of an ALS course alone does not give adequate practical skills for non-anaesthetists to manage an airway in an anaesthetised patient. Airway management at a cardiac arrest is unlikely to be any better.
传统上，麻醉师在复苏团队中提供气道管理技能。由于高级生命支持（ALS）课程教授实用的气道管理，一些英国医院已经将麻醉师从心脏骤停团队中剔除。ALS 课程是否为非麻醉师提供了足够的技能来管理心脏骤停期间的气道？
我们招募了正在接受全身麻醉和喉罩（LMA）插入术的成年外科患者，作为其常规护理的一部分。患者被随机分配给一名初级医生进行气道管理；要么是经过 ALS 培训的麻醉师，要么是经过 ALS 培训的非麻醉师。在麻醉诱导后，使用自动充气袋面罩装置进行五次手动通气，然后插入 LMA。我们记录了手动通气的质量（充分、部分充分或不充分）、LMA 插入的时间以及任何并发症。
20 名麻醉师和 16 名非麻醉师 ALS 毕业生参加了研究。在麻醉师中，18 名（90%）表现出充分的手动通气技能，2 名（10%）表现出部分充分的手动通气技能，而非麻醉师中，5 名（31.25%）表现出充分的手动通气技能，5 名（31.25%）表现出部分充分的手动通气技能，6 名（37.5%）表现出不充分的手动通气技能（p<0.001）。18 名麻醉师（90%）和 4 名非麻醉师（25%）符合 ALS LMA 插入指南规定的 30s 时间（p<0.0001）。麻醉师和非麻醉师插入 LMA 的中位数时间分别为 20.5s（范围 16-40s，n=20）和 35.0s（范围 18-168，n=10）（p<0.05）。16 名非麻醉师中有 6 名（37.5%）未能插入 LMA。非麻醉师组有 4 例并发症（喉痉挛、呕吐和 SaO2<90%）（患者的 25%），而麻醉师组无任何并发症（p=0.01）。
ALS 课程的气道部分单独并不能为非麻醉师提供足够的实践技能来管理麻醉患者的气道。心脏骤停时的气道管理可能不会更好。
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