颈椎固定患者插管时C-MAC与直接喉镜检查的比较：一项人体模型试验。

C-MAC compared with direct laryngoscopy for intubation in patients with cervical spine immobilization: A manikin trial.

作者信息

Smereka Jacek, Ladny Jerzy R, Naylor Amanda, Ruetzler Kurt, Szarpak Lukasz

机构信息

Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.

Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland.

出版信息

Am J Emerg Med. 2017 Aug;35(8):1142-1146. doi: 10.1016/j.ajem.2017.03.030. Epub 2017 Mar 16.

DOI:10.1016/j.ajem.2017.03.030

PMID:28341185

Abstract

INTRODUCTION

The aim of this study was to compare C-MAC videolaryngoscopy with direct laryngoscopy for intubation in simulated cervical spine immobilization conditions.

METHODS

The study was designed as a prospective randomized crossover manikin trial. 70 paramedics with <5years of medical experience participated in the study. The paramedics attempted to intubate manikins in 3 airway scenarios: normal airway without cervical immobilization (Scenario A); manual inline cervical immobilization (Scenario B); cervical immobilization using cervical extraction collar (Scenario C).

RESULTS

Scenario A: Nearly all participants performed successful intubations with both MAC and C-MAC on the first attempt (95.7% MAC vs. 100% C-MAC), with similar intubation times (16.5s MAC vs. 18s C-MAC). Scenario B: The results with C-MAC were significantly better than those with MAC (p<0.05) for the time of intubation (23 s MAC vs. 19 s C-MAC), success of the first intubation attempt (88.6% MAC vs. 100% C-MAC), Cormack-Lehane grade, POGO score, severity of dental compression, device difficulty score, and preferred airway device. Scenario C: The results with C-MAC were significantly better than those with MAC (p<0.05) for all the analysed variables: success of the first attempt (51.4% MAC vs. 100% C-MAC), overall success rate, intubation time (27 s MAC vs. 20.5 s C-MAC), Cormack-Lehane grade, POGO score, dental compression, device difficulty score and the preferred airway device.

CONCLUSION

The C-MAC videolaryngoscope is an excellent alternative to the MAC laryngoscope for intubating manikins with cervical spine immobilization.

摘要

引言

本研究旨在比较在模拟颈椎固定条件下，C-MAC视频喉镜与直接喉镜用于气管插管的效果。

方法

本研究设计为一项前瞻性随机交叉人体模型试验。70名具有<5年医疗经验的护理人员参与了该研究。护理人员在3种气道场景下尝试对人体模型进行气管插管：无颈椎固定的正常气道（场景A）；手动直线颈椎固定（场景B）；使用颈椎提取颈圈进行颈椎固定（场景C）。

结果

场景A：几乎所有参与者在首次尝试时使用MAC和C-MAC都成功进行了气管插管（MAC为95.7%，C-MAC为100%），插管时间相似（MAC为16.5秒，C-MAC为18秒）。场景B：在插管时间（MAC为23秒，C-MAC为19秒）、首次插管尝试成功率（MAC为88.6%，C-MAC为100%）、Cormack-Lehane分级、POGO评分、牙齿压迫严重程度、设备难度评分以及首选气道设备方面，C-MAC的结果明显优于MAC（p<0.05）。场景C：在所有分析变量方面，C-MAC的结果明显优于MAC（p<0.05）：首次尝试成功率（MAC为51.4%，C-MAC为100%）、总体成功率、插管时间（MAC为27秒，C-MAC为20.5秒）、Cormack-Lehane分级、POGO评分、牙齿压迫、设备难度评分以及首选气道设备。