Resuscitation & Emergency Care, Frimley Park Hospital, Surrey, UK.
Resuscitation. 2011 Dec;82(12):1548-52. doi: 10.1016/j.resuscitation.2011.06.020. Epub 2011 Jun 25.
Respiratory failure following chemical exposure can be fatal and although supraglottic airway devices have been evaluated for use in the management of CBRN casualties' intubation remains the gold standard airway.
This is a randomised cross-over study involving 66 paramedic students utilising the following intubating aids bougie, stylet, McCoy laryngoscope, Airtraq™, intubating laryngeal mask (ILMA) and standard intubation. Each participant performed intubation with each device while wearing standard uniform and CBRN-PPE.
While wearing standard uniform all intubation aids, except the Airtraq™, resulted in at least a 90% successful intubation rate by 60s. The use of CBRN-PPE led to significantly longer intubation times (ranging from 14.3 to 20.7s) depending on intubation aid used (p<0.001) with a 90% successful intubation rate not being achieved by all devices even by 150s. While wearing CBRN-PPE standard intubation and intubation with a stylet were the fastest whereas the ILMA was deemed the easiest to use with the highest success rate. A marked deterioration in the number of intubation attempts completed within 30s was also noted with standard intubation deteriorating by 82%, stylet deteriorating by 96% and the McCoy by 100%. The deterioration in intubation success at 60s was less marked.
In this manikin-based study all intubation aids evaluated while wearing CBRN-PPE were adversely affected by the loss of dexterity associated with wearing Butyl gloves. Standard intubation and intubation utilising a stylet resulted in the fastest intubation times; whereas the ILMA offers the highest intubation success rate and was deemed to be the easiest intubating aid to use. An important consideration with regards future research is the impact of a learning curve with regards to different intubation aids and whether preassembling all the intubation aids prior to the intubation attempt may improve intubation speed. The impact of intubator familiarity with regards to individual intubation aids is also an important consideration but established intubation aids like the Bougie are more difficult to use when dexterity is reduced due to CBRN-PPE.
化学暴露后的呼吸衰竭可能是致命的，尽管声门上气道装置已被评估用于管理 CBRN 伤员的插管，但插管仍然是金标准气道。
这是一项涉及 66 名护理学生的随机交叉研究，使用以下插管辅助工具：气管内导管引导器、插管导丝、McCoy 喉镜、Airtraq™、插管喉罩 (ILMA) 和标准插管。每位参与者在穿着标准制服和 CBRN-PPE 的情况下，使用每种设备进行插管。
在穿着标准制服的情况下，除 Airtraq™外，所有插管辅助工具在 60 秒内的插管成功率均至少达到 90%。使用 CBRN-PPE 会导致插管时间显著延长（根据使用的插管辅助工具，范围为 14.3 至 20.7 秒）（p<0.001），即使在 150 秒时，也并非所有设备都能达到 90%的插管成功率。在穿着 CBRN-PPE 的情况下，标准插管和带插管导丝的插管速度最快，而 ILMA 则被认为是最容易使用且成功率最高的。还注意到在 30 秒内完成插管尝试的次数明显减少，标准插管下降 82%，插管导丝下降 96%，McCoy 下降 100%。在 60 秒时，插管成功率的下降不太明显。
在这项基于模型的研究中，评估了所有在穿着 CBRN-PPE 时使用的插管辅助工具，都受到与佩戴丁基手套相关的灵活性丧失的不利影响。标准插管和使用插管导丝的插管速度最快；而 ILMA 提供了最高的插管成功率，被认为是最容易使用的插管辅助工具。未来研究的一个重要考虑因素是不同插管辅助工具的学习曲线的影响，以及在尝试插管之前是否预先组装所有插管辅助工具是否可以提高插管速度。插管者对个体插管辅助工具的熟悉程度也是一个重要的考虑因素，但由于 CBRN-PPE，像气管内导管引导器这样的已建立的插管辅助工具在灵活性降低时更难使用。
