紧急医疗服务人员能否有效地放置和使用声门上气道喉罩（SALT）气道？

Can emergency medical services personnel effectively place and use the Supraglottic Airway Laryngopharyngeal Tube (SALT) airway?

机构信息

Department of Emergency Medicine, University of Nevada School of Medicine, Las Vegas, Nevada 89106, USA.

出版信息

Prehosp Emerg Care. 2011 Jul-Sep;15(3):359-65. doi: 10.3109/10903127.2011.561410. Epub 2011 Apr 26.

DOI:10.3109/10903127.2011.561410

PMID:21521038

Abstract

BACKGROUND

Various alternative airway devices have been developed in the last several years. Among these is the Supraglottic Airway Laryngopharyngeal Tube (SALT), which was designed to function as a basic mechanical airway and as an endotracheal tube (ET) introducer for blind endotracheal intubation (ETI).

OBJECTIVE

To determine the rate of successful placement of the SALT and the success rate of subsequent blind ET insertion by a cohort of emergency medical services (EMS) providers of varying levels of EMS certification.

METHODS

This study was a two-phase, two-group nonblinded, prospective time trial using a convenience cohort of prehospital providers to determine the success rate for SALT placement (i.e., the basic life support [BLS] phase) and ET placement using the SALT (i.e., the advanced life support [ALS] phase) in an unembalmed human cadaver model. The part 1 cohort (group 1) comprised predominantly basic and intermediate emergency medical technician (EMT)-level providers, whereas the part 2 cohort (group 2) comprised exclusively paramedic-level providers.

RESULTS

In group 1, 51 (98%) of the subjects were able to successfully place the SALT and ventilate the cadaver (BLS phase), with 48 (92.3%) subjects successfully placing it on the first attempt. In group 2, 21 (96%) of the subjects were able to successfully place the SALT, with 19 (86%) placing the SALT on the first attempt. Successful blind placement of an ET through the SALT (ALS phase) by group 1 was 48.1% (95% confidence interval [CI]: 34-62), with 37% (95% CI: 24-51) placing the ET on the first attempt. In group 2, 20 subjects (91% [95% CI: 71-99]) were able to successfully place an ET through the SALT, with 13 (59% [95% CI: 36-79]) doing so on the first attempt.

CONCLUSIONS

Emergency medical services providers of varying levels can successfully and rapidly place the SALT and ventilate a cadaver specimen. The success rate for blind placement of an ET through the SALT was suboptimal.

摘要

背景

在过去的几年中，已经开发出了各种替代气道设备。其中一种是声门上气道喉罩管（SALT），它旨在作为基本的机械气道，并作为盲探气管内插管（ETI）的气管内导管（ET）导入器。

目的

确定不同级别的急救医疗服务（EMS）提供者对 SALT 进行成功放置的比例，以及随后通过 SALT 进行盲探 ET 插入的成功率。

方法

这项研究是一个两阶段、两群组的非盲、前瞻性时间试验，使用方便的院前提供者队列来确定 SALT 放置（即基础生命支持 [BLS] 阶段）的成功率，以及使用 SALT 进行 ET 放置（即高级生命支持 [ALS] 阶段）的成功率，使用未防腐的人体尸体模型。第 1 部分队列（第 1 组）主要由基本和中级 EMT 级别的急救医疗技术员组成，而第 2 部分队列（第 2 组）仅由护理人员级别的急救医疗技术员组成。

结果

在第 1 组中，51 名（98%）受试者能够成功地放置 SALT 并对尸体进行通气（BLS 阶段），其中 48 名（92.3%）受试者在第一次尝试时成功放置。在第 2 组中，21 名（96%）受试者能够成功地放置 SALT，其中 19 名（86%）在第一次尝试时放置 SALT。第 1 组通过 SALT 成功进行盲探 ET 放置（ALS 阶段）的比例为 48.1%（95%置信区间 [CI]：34-62），其中 37%（95% CI：24-51）在第一次尝试时放置 ET。在第 2 组中，20 名受试者（91%[95%CI：71-99%]）能够成功地通过 SALT 放置 ET，其中 13 名（59%[95%CI：36-79%]）在第一次尝试时这样做。