Department of Anaesthesiology, Critical Care and Prehospital Emergency Medicine, Hôpitaux Universitaires de Strasbourg, University of Strasbourg, BP 426, 67098 Strasbourg, France; Fire and Rescue Department Bas-Rhin, 2 Route de Paris, 67087 Strasbourg Cedex 2, France.
Department of Anaesthesiology & University of Ottawa Skills and Simulation Centre (uOSSC), The Ottawa Hospital, The Academy for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, 501 Smyth Road, Ottawa K1H 8L6, Ontario, Canada.
Resuscitation. 2014 Mar;85(3):320-5. doi: 10.1016/j.resuscitation.2013.11.006. Epub 2013 Nov 25.
The role of supralaryngeal devices in airway management in out-of-hospital cardiac arrests (OHCA) remains controversial. The aim of this prospective observational trial was to evaluate the feasibility and effectiveness of intubating laryngeal mask airway (ILMA) when used by trained prehospital emergency nurses in the setting of OHCA.
After approval from the Research Ethics Board, prehospital emergency nurses trained in placement of ILMA (Fastrach™, LMA Vitaid, Toronto, Ontario, Canada) followed a formal protocol for airway control during OHCA. The primary outcome was the success rate of ILMA placement, while secondary outcomes were success rate of tracheal intubation through the ILMA, and the incidence of regurgitation of gastric contents.
During the study period, 302 ILMA placements were attempted by emergency nurses during OHCA resuscitation. After ILMA placement, but before attempt for intubation, ventilation was possible in 290 patients (96%). Obstruction or major leaks were observed in 12 patients (4%). Tracheal tube insertion through the ILMA was attempted in 265 patients, and was performed in 254 (95.8%). This allowed for proper lung ventilation through the tracheal tube in 242 cases whereas 12 tubes were esophageal or proved obstructed. Regurgitation of gastric contents occurred in 43 (14.2%) patients; in 23 cases before arrival of the first aid team, in 18 cases before ILMA placement, and in 2 cases after the ILMA placement.
The use of ILMA for airway management by trained emergency nurses during OHCA resuscitation is feasible and allows for effective airway management. The success rate of tracheal tube placement through the ILMA was high. In addition, the incidence of regurgitation was lower when using the ILMA than that previous historical reports with face-mask ventilation.
在院外心脏骤停（OHCA）中，上呼吸道装置在气道管理中的作用仍存在争议。本前瞻性观察性试验的目的是评估经过培训的院前急救护士在 OHCA 环境中使用喉罩气道（ILMA）的可行性和有效性。
在获得研究伦理委员会批准后，经过培训可放置 ILMA（Fastrach™，LMA Vitaid，多伦多，安大略省，加拿大）的院前急救护士遵循 OHCA 期间气道控制的正式方案。主要结局是 ILMA 放置的成功率，次要结局是通过 ILMA 进行气管插管的成功率以及胃内容物反流的发生率。
在研究期间，302 名急救护士在 OHCA 复苏期间尝试进行 ILMA 放置。ILMA 放置后，但在尝试插管之前，290 名患者（96%）可进行通气。在 12 名患者（4%）中观察到阻塞或严重泄漏。在 265 名患者中尝试通过 ILMA 插入气管导管，其中 254 名（95.8%）成功。这使得 242 例患者能够通过气管导管进行适当的肺部通气，而 12 例导管为食管或证实阻塞。43 名（14.2%）患者发生胃内容物反流；在急救小组到达前 23 例，在 ILMA 放置前 18 例，在 ILMA 放置后 2 例。
在 OHCA 复苏期间，经过培训的急救护士使用 ILMA 进行气道管理是可行的，并且可以进行有效的气道管理。通过 ILMA 放置气管导管的成功率较高。此外，与以前使用面罩通气的历史报告相比，使用 ILMA 时反流的发生率较低。
