Air Ambulance Department, Oslo University Hospital, Sykehusveien 19, N-1474 Nordbyhagen, Norway.
Scand J Trauma Resusc Emerg Med. 2011 Jun 13;19:36. doi: 10.1186/1757-7241-19-36.
Alternatives to endotracheal intubation (ETI) are required when access to the cranial end of the patient is restricted. In this study, the success rate and time duration of standard intubation techniques were compared with two different supraglottic devices. Two different manikins were used for the study, and the training effect was studied when the same manikin was repeatedly used.
Twenty anaesthesiologists from the Air Ambulance Department used iGEL™, laryngeal tube LTSII™ and Macintosh laryngoscopes in two scenarios with either unrestricted (scenario A) or restricted (scenario B) access to the cranial end of the manikin. Different manikins were used for ETI and placement of the supraglottic devices. The technique selected by the physicians, the success rates and the times to completion were the primary outcomes measured. A secondary outcome of the study was an evaluation of the learning effect of using the same manikin or device several times.
In scenario A, all anaesthesiologists secured an airway using each device within the maximum time limit of 60 seconds. In scenario B, all physicians secured the airway on the first attempt with the supraglottic devices and 16 (80%) successfully performed an ETI with either the Macintosh laryngoscope (n = 13, 65%) or with digital technique (n = 3, 15%). It took significantly longer to perform ETI (mean time 28.0 sec +/- 13.0) than to secure an airway with the supraglottic devices (iGel™: mean 12.3 sec +/- 3.6, LTSII™: mean 10.6 sec +/- 3.2). When comparing the mean time required for the two scenarios for each supraglottic device, there was a reduction in time for scenario B (significant for LTSII™: 12.1 versus 10.6 seconds, p = 0.014). This may be due to a training effect using same manikin and device several times.
The amount of time used to secure an airway with supraglottic devices was low for both scenarios, while classic ETI was time consuming and had a low success rate in the simulated restricted access condition. This study also demonstrates that there is a substantial training effect when simulating airway management with airway manikins. This effect must be considered when performing future studies.
当患者头部无法接近时，需要替代气管插管（ETI）。在这项研究中，比较了标准插管技术与两种不同的声门上设备的成功率和时间持续时间。研究使用了两种不同的模型，并且研究了重复使用相同模型时的培训效果。
20 名来自空中救护部门的麻醉师在两种情况下使用 iGEL™、Laryngeal Tube LTSII™和 Macintosh 喉镜，一种是对模型头部无障碍的情况（场景 A），另一种是有障碍的情况（场景 B）。不同的模型用于 ETI 和放置声门上设备。医生选择的技术、成功率和完成时间是主要的测量结果。该研究的次要结果是评估使用相同模型或设备多次的学习效果。
在场景 A 中，所有麻醉师都在 60 秒的最大时间限制内使用每种设备成功建立了气道。在场景 B 中，所有医生都在第一次尝试时使用声门上设备成功建立了气道，并且 16 名（80%）医生通过 Macintosh 喉镜（n=13，65%）或数字技术（n=3，15%）成功进行了 ETI。进行 ETI 所需的时间明显更长（平均时间 28.0 秒 +/- 13.0），而使用声门上设备建立气道的时间更短（iGel™：平均 12.3 秒 +/- 3.6，LTSII™：平均 10.6 秒 +/- 3.2）。比较两种声门上设备在每个场景中的平均时间，场景 B 的时间有所减少（LTSII™显著减少：12.1 秒对 10.6 秒，p=0.014）。这可能是由于使用相同模型和设备多次进行训练的效果。
在两种情况下，使用声门上设备建立气道的时间都很短，而经典的 ETI 耗时且在模拟受限条件下成功率低。这项研究还表明，使用气道模型模拟气道管理时存在显著的培训效果。在进行未来的研究时，必须考虑到这一效果。
