Clinic of Anesthesiology, Intensive Care Medicine, and Pain Therapy, JW Goethe University Hospital Frankfurt, Frankfurt, Germany.
Prehosp Emerg Care. 2011 Jul-Sep;15(3):347-50. doi: 10.3109/10903127.2011.561405. Epub 2011 Apr 26.
Endotracheal intubation (ETI) is considered to be the "gold standard" of prehospital airway management of trauma patients. However, ETI requires substantial technical skills and ongoing experience. Because failed prehospital ETI is common and associated with a higher mortality, reliable airway devices are needed to be used by rescuers who are less experienced in ETI.
To prospectively evaluate the feasibility of the use of laryngeal tubes by paramedics and emergency physicians for out-of-hospital airway management in trauma patients.
During a 40-month period, data for all cases of prehospital use of the laryngeal tube suction disposable (LTS-D) within a large metropolitan area were recorded by a standardized questionnaire. We determined indications for laryngeal tube use, placement success, number of placement attempts, placement time, and personal level of experience. All patients admitted to our institution also underwent in-hospital follow-up.
Fifty-six of 57 prehospital intubations attempts with the LTS-D were successfully performed by paramedics (n = 19) or emergency physicians (n = 37) within one (n = 50) or two (n = 6) placement attempts. The device was used as initial airway (n = 27) or rescue device after failed ETI (n = 30). The placement time was ≤ 45 seconds (n = 42), 46-90 seconds (n = 13), and >90 seconds (n = 1). The majority of users (n = 44) were relative novices with no more than 10 previous laryngeal tube placements on actual patients. Of 33 patients eligible for follow-up, one underwent urgent LTS-D removal and subsequent ETI upon hospital admission, six underwent ETI after primary survey, and 26 underwent both primary and secondary survey or even damage-control surgery with the LTS-D.
The LTS-D represents a promising alternative to ETI in the hands of both paramedics and emergency physicians. It can be used as an initial tool to secure the airway until ETI is prepared, as a definitive airway by rescuers less experienced in ETI, or as a rescue device when ETI has failed.
气管插管（ETI）被认为是创伤患者院前气道管理的“金标准”。然而，ETI 需要大量的技术技能和持续的经验。由于院前 ETI 失败很常见，且与死亡率升高相关，因此需要经验较少的救援人员使用可靠的气道设备。
前瞻性评估急救员和急诊医师在创伤患者院前气道管理中使用喉管的可行性。
在 40 个月期间，通过标准化问卷记录了在一个大都市区内所有院前使用一次性喉管抽吸（LTS-D）的病例数据。我们确定了喉管使用的适应证、放置成功率、放置尝试次数、放置时间以及个人经验水平。所有收入我院的患者还接受了院内随访。
57 例院前 LTS-D 插管尝试中，急救员（n=19）或急诊医师（n=37）一次（n=50）或两次（n=6）放置尝试后均成功。该装置被用作初始气道（n=27）或 ETI 失败后的抢救装置（n=30）。放置时间≤45 秒（n=42）、46-90 秒（n=13）和>90 秒（n=1）。大多数使用者（n=44）为相对新手，实际患者中仅进行过不超过 10 次喉管放置。33 例符合随访条件的患者中，1 例在入院时行紧急 LTS-D 移除及随后的 ETI，6 例行初级检查后行 ETI，26 例行初级和二级检查，甚至在使用 LTS-D 行损伤控制性手术。
在急救员和急诊医师手中，LTS-D 是 ETI 的一种有前途的替代方法。它可作为准备 ETI 期间的初始工具，用于固定气道，也可作为经验较少的 ETI 救援人员的确定性气道，或者在 ETI 失败时作为抢救装置。
