Ota Kohei, Sadamori Takuma, Kusunoki Shinji, Otani Tadatsugu, Tamura Tomoko, Une Kazunobu, Kida Yoshiko, Itai Junji, Iwasaki Yasumasa, Hirohashi Nobuyuki, Nakao Masakazu, Tanigawa Koichi
Department of Emergency and Critical Care Medicine, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima, 734-8551, Japan.
Emergency Medical Center, Hiroshima Prefectural Hospital, Hiroshima, Japan.
J Anesth. 2015 Oct;29(5):672-7. doi: 10.1007/s00540-014-1960-1. Epub 2014 Dec 20.
We sought to establish the clinical utility of the Pentax-AWS Airway Scope(®) (AWS) when used by paramedics to intubate the trachea, and to evaluate whether their performance was influenced by previous clinical experience with the Macintosh laryngoscope (ML).
Twenty paramedics attempted tracheal intubation using the AWS in five patients each in the operating room. We recorded the success rate, the number of intubation attempts, and the time for intubation and adverse events, and compared these based on the paramedics' previous clinical experience with the ML. Ten paramedics had no prior clinical experience of the ML (group A) and 10 had used it on more than 30 occasions (group B).
The intubation success rate was 99 % (99/100). Notably, 96 % (47/49) of intubations were achieved on the first attempt by the inexperienced paramedics in group A, compared with 64 % (32/50) by the experienced paramedics in group B (p = 0.0001). The time to intubation (mean ± SD) was significantly shorter in group A than in group B (37 ± 24 vs. 48 ± 21 s, p = 0.002). There were marked variations in the times taken to intubate, but no apparent improvement as the intubators gained experience between their first and fifth cases. No complications were encountered in either group.
We found that paramedics could achieve a high tracheal intubation success rate using the AWS independent of previous airway management experience. Better intubation performance with the AWS was observed in paramedics without clinical experience with the ML.
我们试图确定护理人员使用宾得AWS气道镜（AWS）进行气管插管的临床实用性，并评估他们的操作表现是否受到先前使用麦金托什喉镜（ML）临床经验的影响。
20名护理人员在手术室中对5名患者每人使用AWS尝试进行气管插管。我们记录成功率、插管尝试次数、插管时间和不良事件，并根据护理人员先前使用ML的临床经验进行比较。10名护理人员此前没有使用ML的临床经验（A组），10名护理人员使用ML超过30次（B组）。
插管成功率为99%（99/100）。值得注意的是，A组中没有经验的护理人员首次尝试插管的成功率为96%（47/49），而B组中有经验的护理人员为64%（32/50）（p = 0.0001）。A组的插管时间（平均值±标准差）明显短于B组（37±24 vs. 48±21秒，p = 0.002）。插管时间存在显著差异，但插管人员在第一例到第五例之间积累经验后，插管时间没有明显改善。两组均未出现并发症。
我们发现，护理人员使用AWS可获得较高的气管插管成功率，且与先前的气道管理经验无关。在没有使用ML临床经验的护理人员中，观察到使用AWS的插管表现更好。
