Schober Patrick, Krage Ralf, van Groeningen Dick, Loer Stephan A, Schwarte Lothar A
Department of Anaesthesiology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
Emerg Med J. 2014 Dec;31(12):959-63. doi: 10.1136/emermed-2012-202064. Epub 2013 Sep 4.
Airway management in entrapped casualties with restricted access to the head is challenging. If tracheal intubation is required and conventional laryngoscopy is not possible, intubation must be attempted in a face-to-face approach. Traditionally, this is performed with a standard laryngoscope held in the right hand with the blade facing upward. Recently, alternative methods have been developed to facilitate difficult intubations, and we hypothesised that such techniques are also useful for face-to-face intubations.
24 (trainee) anaesthesiologists attempted tracheal intubation in a patient simulator (SimMan, Laerdal, Norway) using three techniques in random order: (1) direct laryngoscopy (Macintosh blade #3), (2) indirect optical laryngoscopy (Airtraq, Prodol, Spain) and (3) video laryngoscopy (McGrath, Aircraft Medical, UK). The manikin was sitting with the neck immobilised and only accessible from the left anterolateral side. Success rate (percentage (95% CI)) and tube insertion time (median (IQR)) were recorded.
Success rate did not differ significantly (Airtraq and McGrath 100% (84% to 100%), direct laryngoscopy 88% (68% to 96%)). Intubation was faster with Airtraq (25 s (22-34), p<0.001) and direct laryngoscopy (34 s (22-48), p<0.05) compared with the McGrath technique (55 s (37-96)).
All three techniques have a high success rate, but the usefulness of the video laryngoscope is limited due to longer intubation duration. Inverse direct laryngoscopy showed reasonable intubation times and, given the widespread availability of Macintosh laryngoscopes, seems a useful technique. Intubation was always successful and tended to be fastest with the Airtraq device, suggesting that this technique may be a promising alternative.
对于头部受限的被困伤员，气道管理具有挑战性。如果需要气管插管且无法进行传统喉镜检查，则必须尝试采用面对面的方法进行插管。传统上，这是通过右手持标准喉镜且镜片向上来进行的。最近，已开发出替代方法以促进困难插管，我们推测此类技术对于面对面插管也有用。
24名（实习）麻醉医生在患者模拟器（挪威Laerdal公司的SimMan）中使用三种技术以随机顺序尝试气管插管：（1）直接喉镜检查（3号Macintosh镜片），（2）间接光学喉镜检查（西班牙Prodol公司的Airtraq）和（3）视频喉镜检查（英国Aircraft Medical公司的McGrath）。人体模型坐着，颈部固定，只能从左前外侧接近。记录成功率（百分比（95%置信区间））和插管时间（中位数（四分位间距））。
成功率无显著差异（Airtraq和McGrath为100%（84%至100%），直接喉镜检查为88%（68%至96%））。与McGrath技术（55秒（37至96））相比，Airtraq（25秒（22 - 34），p<0.001）和直接喉镜检查（34秒（22 - 48），p<0.05）的插管速度更快。
所有三种技术成功率都很高，但视频喉镜的实用性因插管持续时间较长而受限。反向直接喉镜检查显示插管时间合理，且鉴于Macintosh喉镜广泛可得，似乎是一种有用的技术。使用Airtraq设备插管总是成功且往往最快，表明该技术可能是一种有前景的替代方法。
