Department of Anesthesiology, Emergency and Critical Care Medicine and Karl Landsteiner Institute of Emergency Medicine, General Hospital, Wiener Neustadt, Austria.
Crit Care Med. 2011 Mar;39(3):489-93. doi: 10.1097/CCM.0b013e318206b69b.
The optical Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain) has been shown to have advantages when compared with direct laryngoscopy in difficult airway patients. Furthermore, it has been suggested that it is easy to use and handle even for inexperienced advanced life support providers. As such, we sought to assess whether the Airtraq may be a reliable alternative to conventional intubation when used in the prehospital setting.
DESIGN, SETTING, AND PATIENTS: Prospective, randomized control trial in emergency patients requiring endotracheal intubation provided by anesthesiologists or emergency physicians responding with an emergency medical service helicopter or ground unit associated with the Department of Anesthesiology, General Hospital, Wiener Neustadt, Austria.
During the 18-month study period, 212 patients were enrolled. When the Airtraq was used as first-line airway device (n=106) vs. direct laryngoscopy (n=106), success rate was 47% vs. 99%, respectively (p<.001). Reasons for failed Airtraq intubation were related to the fiber-optic characteristic of this device (i.e., impaired sight due to blood and vomitus, n=11) or to assumed handling problems (i.e., cuff damage, tube misplacement, or inappropriate visualization of the glottis, n=24). In 54 of 56 patients where Airtraq intubation failed, direct laryngoscopy was successful on the first attempt; in the remaining two and in one additional case of failed direct laryngoscopy, the airway was finally secured employing the Fastrach laryngeal mask. There was no correlation between success rates and body mass index, age, indication for airway management, emergency medical service unit, or experience of the physicians.
Based on these results, the use of the Airtraq laryngoscope as a primary airway device cannot be recommended in the prehospital setting without significant clinical experience obtained in the operation room. We conclude that the clinical learning process of the Airtraq laryngoscope is much longer than reported in the anesthesia literature.
与直接喉镜相比，光学可视喉镜（Prodol Meditec，Vizcaya，西班牙）在困难气道患者中具有优势。此外，有人认为，即使是没有经验的高级生命支持提供者，也很容易使用和操作。因此，我们试图评估在院前环境中使用时，Airtraq 是否可以替代常规插管。
设计、地点和患者：前瞻性、随机对照试验，纳入需要气管插管的急诊患者，由麻醉医师或急诊科医师使用与奥地利维也纳新城总医院麻醉科相关的紧急医疗服务直升机或地面单位进行。
在 18 个月的研究期间，共纳入 212 例患者。当 Airtraq 作为一线气道设备（n=106）与直接喉镜（n=106）使用时，成功率分别为 47%和 99%（p<.001）。Airtraq 插管失败的原因与该设备的光纤特性有关（即由于血液和呕吐物导致视线受损，n=11）或与假定的操作问题有关（即，套囊损坏、管放置不当或声门的不当可视化，n=24）。在 56 例 Airtraq 插管失败的患者中，54 例患者直接喉镜首次尝试即成功；在其余两例和一例直接喉镜再次失败的患者中，最终通过使用 Fastrach 喉罩来确保气道畅通。成功率与体重指数、年龄、气道管理指征、紧急医疗服务单位或医师经验之间无相关性。
基于这些结果，如果没有在手术室获得的显著临床经验，不能推荐在院前环境中使用 Airtraq 喉镜作为主要气道设备。我们得出结论，Airtraq 喉镜的临床学习过程比麻醉文献中报道的要长得多。
