Hensel Mario, Schmidbauer Willi, Benker Michael, Schmieder Paula, Kerner Thoralf
Department of Anesthesiology and Intensive Care Medicine, Park-Klinik-Weissensee, 13086 Berlin, Schönstrasse 80, Germany.
Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, Combat Search and Rescue German Army, Air Force and Navy Hospital Bundeswehrkrankenhaus Berlin (BWK Berlin), Scharnhorststrasse 13, 10115 Berlin, Germany.
Mil Med. 2017 Mar;182(3):e1774-e1781. doi: 10.7205/MILMED-D-16-00252.
The use of supraglottic airways has been recommended in combat trauma airway management. To ensure an adequate airway management on the battlefield, suitable training concepts are sought to efficiently teach as many soldiers as possible. Our aim was to compare three approaches of teaching laypersons in the handling of supraglottic airways in a mannequin model.
In this prospective randomized blinded study, 285 military service men without any medical background were divided into three groups and trained in the use of the Laryngeal Mask Airway Supreme (LMA) and the Laryngeal Tube Disposable (LT-D). The first group received a theoretical lecture, the second group was shown an instruction video, and the third group underwent a practical training. Immediately after instruction participants were asked to place the supraglottic airway and ventilate the mannequin within 60 seconds. The entire test was repeated 3 months later. Test results were evaluated with regard to success rate, insertion time, ability to judge the correct placement, and degree of difficulty.
Practical training showed the highest success rate when placing supraglottic airways immediately after the instruction (lecture: 68%, video: 74%, training: 94%); (training vs. lecture and training vs. video, p < 0.001) as well as 3 months later (lecture: 63%, video: 66%, training: 78%); (training vs. lecture, p = 0.019 and training vs. video, p = 0.025). Immediately after the instruction practical training was also superior in terms of insertion time, ability to judge the correct placement, and the self-rated degree of difficulty (p < 0.001). These effects were significantly reduced 3 months after the instruction. In comparison between supraglottic airways LT-D was superior to LMA regarding all the outcome parameters mentioned above (p < 0.001).
In this study, performed with personnel of the German Armed Forces, we have shown that persons without any medical and paramedical background are able to successfully place a supraglottic airway immediately following minimal instruction and after 3 months as well. Study participants achieved the best results after practical training followed by video presentation and finally lecture regardless of the airway device used. There are two possible reasons why practical training is the superior method. Firstly, the success is tied to more time spent with the learners. Secondly, practical training seems to be the best teaching method for various types of learners such as visual, auditory, reading/writing, and kinesthetic type. In addition the results of our study show that the LT-D is an ideal supraglottic airway in the hands of people inexperienced in airway management. In conclusion, our results show that practical training is the superior instruction method compared to theoretical lecture and presentation of an instruction video. Nevertheless, the presentation of an instruction video is a promising approach of teaching a maximum number of laypersons with minimal effort to correctly place supraglottic airways. To optimize the success rate of such a concept LT-Ds instead of LMAs should be used for airway management. The presented concepts hold promise for combat as well as for civilian emergency medicine.
声门上气道已被推荐用于战斗创伤气道管理。为确保战场上的气道管理得当，人们在寻找合适的训练理念，以便有效地培训尽可能多的士兵。我们的目的是比较在人体模型中向非专业人员教授声门上气道操作的三种方法。
在这项前瞻性随机双盲研究中，285名无任何医学背景的军人被分为三组，接受喉罩至尊版（LMA）和一次性喉管（LT-D）使用的培训。第一组接受理论讲座，第二组观看教学视频，第三组进行实践培训。培训结束后，立即要求参与者在60秒内放置声门上气道并对人体模型进行通气。3个月后重复整个测试。根据成功率、插入时间、判断正确放置的能力和难度程度对测试结果进行评估。
实践培训在培训后立即放置声门上气道时显示出最高的成功率（讲座组：68%，视频组：74%，培训组：94%）；（培训组与讲座组以及培训组与视频组相比，p<0.001）以及3个月后（讲座组：63%，视频组：66%，培训组：78%）；（培训组与讲座组相比，p = 0.019，培训组与视频组相比，p = 0.025）。培训后立即进行实践培训在插入时间、判断正确放置的能力和自我评定的难度程度方面也更优（p<0.001）。这些效果在培训3个月后显著降低。在声门上气道之间的比较中，就上述所有结果参数而言，LT-D优于LMA（p<0.001）。
在这项针对德国武装部队人员进行的研究中，我们表明，没有任何医学和辅助医疗背景的人员在接受最少的培训后以及3个月后都能够成功放置声门上气道。无论使用何种气道装置，研究参与者在实践培训后取得的结果最佳，其次是观看视频，最后是讲座。实践培训是更优方法可能有两个原因。首先，成功与花费在学习者身上的更多时间相关。其次，实践培训似乎是针对各种类型学习者（如图像型、听觉型、读写型和动觉型）的最佳教学方法。此外，我们的研究结果表明，对于气道管理经验不足的人来说，LT-D是一种理想的声门上气道。总之，我们的结果表明，与理论讲座和教学视频展示相比，实践培训是更优的教学方法。然而，教学视频展示是一种有前景的方法，能够以最小的努力教授最多的非专业人员正确放置声门上气道。为了优化这种理念的成功率，应使用LT-D而不是LMA进行气道管理。所提出的理念对战斗以及民用急救医学都有前景。
