Komasawa Nobuyasu, Ueki Ryusuke, Kaminoh Yoshiroh, Nishi Shin-Ichi
Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka, 569-8686, Japan,
J Anesth. 2014 Oct;28(5):676-80. doi: 10.1007/s00540-014-1802-1. Epub 2014 Feb 22.
In the 2010 American Heart Association guidelines, supraglottic devices (SGDs) such as the laryngeal mask are proposed as alternatives to tracheal intubation for cardiopulmonary resuscitation. Some SGDs can also serve as a means for tracheal intubation after successful ventilation. The purpose of this study was to evaluate the effect of chest compression on airway management with four intubating SGDs, aura-i (aura-i), air-Q (air-Q), i-gel (i-gel), and Fastrack (Fastrack), during cardiopulmonary resuscitation using a manikin.
Twenty novice physicians inserted the four intubating SGDs into a manikin with or without chest compression. Insertion time and successful ventilation rate were measured. For cases of successful ventilation, blind tracheal intubation via the intubating SGD was performed with chest compression and success or failure within 30 s was recorded.
Chest compression did not decrease the ventilation success rate of the four intubating SGDs (without chest compression (success/total): air-Q, 19/20; aura-i, 19/20; i-gel, 18/20; Fastrack, 19/20; with chest compression: air-Q, 19/20; aura-i, 19/20; i-gel, 16/20; Fastrack, 18/20). Insertion time was significantly lengthened by chest compression in the i-gel trial (P < 0.05), but not with the other three devices. The blind intubation success rate with chest compression was the highest in the air-Q trial (air-Q, 15/19; aura-i, 14/19; i-gel, 12/16; Fastrack, 10/18).
This simulation study revealed the utility of intubating SGDs for airway management during chest compression.
在2010年美国心脏协会指南中，喉罩等声门上装置被提议作为心肺复苏时气管插管的替代方法。一些声门上装置在成功通气后还可作为气管插管的一种手段。本研究的目的是使用人体模型评估在心肺复苏过程中胸部按压对四种可插管声门上装置（aura-i、air-Q、i-gel和Fastrack）气道管理的影响。
20名新手医生在有或没有胸部按压的情况下将四种可插管声门上装置插入人体模型。测量插入时间和成功通气率。对于成功通气的病例，通过可插管声门上装置进行盲法气管插管，并进行胸部按压，记录30秒内的成功或失败情况。
胸部按压并未降低四种可插管声门上装置的通气成功率（无胸部按压（成功/总数）：air-Q，19/20；aura-i，19/20；i-gel，18/20；Fastrack，19/20；有胸部按压：air-Q，19/20；aura-i，19/20；i-gel，16/20；Fastrack，18/20）。在i-gel试验中，胸部按压显著延长了插入时间（P<0.05），但其他三种装置则没有。在air-Q试验中，胸部按压时盲法插管成功率最高（air-Q，15/19；aura-i，14/19；i-gel，12/16；Fastrack，10/18）。
这项模拟研究揭示了可插管声门上装置在胸部按压期间气道管理中的实用性。
