Okada Daisuke, Komasawa Nobuyasu, Fujiwara Shunsuke, Minami Toshiaki
Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka, 569-8686, Japan.
J Anesth. 2015 Jun;29(3):331-337. doi: 10.1007/s00540-014-1936-1. Epub 2014 Oct 28.
Previous studies have shown the utility of indirect glottis viewing videolaryngoscopes for tracheal intubation during chest compression, but the efficacy of a videolaryngoscope with tube guide has not been sufficiently validated. We compared the utility of two videolaryngoscopes, the KingVISION(®) (KingV) with or without tube guide blade and Pentax-AWS Airwayscope(®) (AWS), which contain tube guide function, during chest compressions on an adult manikin.
Twenty-five novice doctors and 22 experienced anesthesiologists performed tracheal intubation on an adult manikin using the AWS and KingV with or without chest compressions. The KingV trials were performed either with a tube guide 'channeled blade' (KingV-Guided) or without, using a 'standard blade' (KingV-Guideless).
In the KingV-Guideless trial, all novice doctors successfully secured the airway without chest compressions but seven failed with chest compressions (p < 0.05), while no experienced doctors failed without chest compression and two did during chest compression. In the AWS and KingV-Guided trials, all participants succeeded both with and without chest compressions performed by both novice doctors and experienced anesthesiologists. Intubation time was lengthened significantly by chest compressions in the KingV-Guideless trial (p < 0.05), but not in the AWS or KingV-Guided trials performed by both novice doctors and experienced anesthesiologists. The intubation time for KingV-Guided during chest compression was significantly smaller by experienced anesthesiologists compared to by novice doctors.
These findings suggest that the AWS and KingV-Guided devices are more effective than the KingV-Guideless for airway management with chest compressions in adult simulations, especially performed by novice doctors. The tube guide function may contribute to successful airway management during chest compression by the added videolaryngoscopy function.
先前的研究已表明间接喉镜视频喉镜在胸外按压期间用于气管插管的效用，但带管芯导向的视频喉镜的有效性尚未得到充分验证。我们比较了两种视频喉镜在成年人体模型胸外按压期间的效用，即带或不带管芯导向叶片的KingVISION(®)（KingV）和具有管芯导向功能的宾得AWS Airwayscope(®)（AWS）。
25名新手医生和22名经验丰富的麻醉医生使用AWS和带或不带胸外按压的KingV在成年人体模型上进行气管插管。KingV试验使用带管芯导向的“通道叶片”（KingV-导向型）或不带管芯导向的“标准叶片”（KingV-无导向型）进行。
在KingV-无导向型试验中，所有新手医生在无胸外按压时均成功建立气道，但有7名在胸外按压时失败（p<0.05），而没有经验的医生在无胸外按压时没有失败，有2名在胸外按压时失败。在AWS和KingV-导向型试验中，新手医生和经验丰富的麻醉医生在有和没有胸外按压的情况下所有参与者均成功。在KingV-无导向型试验中，胸外按压显著延长了插管时间（p<0.05），但在新手医生和经验丰富的麻醉医生进行的AWS或KingV-导向型试验中没有延长。与新手医生相比，经验丰富的麻醉医生在胸外按压期间KingV-导向型的插管时间明显更短。
这些发现表明，在成人模拟中进行胸外按压时，AWS和KingV-导向型设备在气道管理方面比KingV-无导向型更有效，尤其是由新手医生操作时。管芯导向功能可能通过增加的视频喉镜功能有助于胸外按压期间成功的气道管理。
