Steinmann Daniel, Ahne Thomas, Heringhaus Christian, Goebel Ulrich
aOccupational Medical ServicebDepartment of Anaesthesiology, University Medical Center Freiburg, Freiburg, GermanycDepartment of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Emerg Med. 2016 Aug;23(4):279-285. doi: 10.1097/MEJ.0000000000000254.
Emergency airway management can be particularly challenging in patients entrapped in crashed cars because of limited access. The aim of this study was to analyse the feasibility of four different airway devices in various standardized settings utilized by paramedics and emergency physicians.
Twenty-five paramedics and 25 emergency physicians were asked to perform advanced airway management in a manikin entrapped in a car's left front seat, with access to the patient through the opened driver's door or access from the back seat. Available airway devices included Macintosh and Airtraq laryngoscopes, as well as laryngeal mask airway (LMA) Supreme and the Laryngeal Tube. The primary endpoints were successful placement, along with attempts needed to do so, and time for successful placement. The secondary endpoints included Cormack-Lehane grades and rating of the difficulty of the technique with the different devices.
The overall intubation and placement success rates were equal for the Macintosh and Airtraq laryngoscopes as well as the LMA Supreme and Laryngeal Tube, with access from the back seat being superior in terms of placement time and ease of use. Supraglottic airway devices required half of the placement time and were easier to use compared with endotracheal tubes (with placement times almost >30 s). Paramedics and emergency physicians achieved equal overall successful placement rates for all devices.
Both scenarios of securing the airway seem suitable in this manikin study, with access from the back seat being superior. Although all airway devices were applicable by both groups, paramedics and emergency physicians, supraglottic device placement was faster and always possible at the first attempt. Therefore, the LMA Supreme and the Laryngeal Tube are attractive alternatives for airway management in this context if endotracheal tube placement fails. Furthermore, supraglottic device placement, while the patient is still in the vehicle, followed by a definitive airway once the patient is extricated would be a worthwhile alternative course of action.
由于通道受限，对被困在撞毁汽车中的患者进行紧急气道管理可能极具挑战性。本研究的目的是分析四种不同气道装置在护理人员和急诊医生使用的各种标准化场景中的可行性。
要求25名护理人员和25名急诊医生在被困于汽车左前座的人体模型上进行高级气道管理，可通过打开的驾驶员车门接近患者或从后座接近。可用的气道装置包括麦金托什喉镜和Airtraq喉镜，以及喉罩气道（LMA）至尊型和喉管。主要终点是成功置入，以及置入所需的尝试次数和成功置入的时间。次要终点包括科马克-莱汉内分级以及不同装置技术难度的评分。
麦金托什喉镜和Airtraq喉镜以及LMA至尊型和喉管的总体插管和置入成功率相同，从后座接近在置入时间和易用性方面更具优势。声门上气道装置所需的置入时间为气管内插管的一半，并且与气管内插管相比更容易使用（气管内插管的置入时间几乎>30秒）。护理人员和急诊医生对所有装置的总体成功置入率相同。
在本人体模型研究中，两种气道固定场景似乎都适用，从后座接近更具优势。尽管两组人员（护理人员和急诊医生）都可使用所有气道装置，但声门上装置的置入速度更快，且首次尝试时总能成功。因此，如果气管内插管置入失败，在这种情况下，LMA至尊型和喉管是气道管理的有吸引力的替代方案。此外，在患者仍在车内时置入声门上装置，然后在患者被救出后建立确定性气道，将是一个值得考虑的替代行动方案。
