Liu Zi-Jia, Yi Jie, Chen Wei-Yun, Zhang Xiu-Hua, Huang Yu-Guang
Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China.
Medicine (Baltimore). 2017 May;96(19):e6905. doi: 10.1097/MD.0000000000006905.
Intubating laryngeal mask airways (LMAs) such as i-gel and Aura-i could serve as rescue devices in resuscitation and further ensure the airway by facilitating trachea intubation without ventilation interruption. But data regarding intubating LMAs in novice are limited and skill degeneration without regular training has not been evaluated. So we designed this prospective randomized crossover manikin study to compare the learning performance of 2 intubating LMAs (i-gel and Aura-i).
In total, 46 novice doctors participated in this study. After standardized training and finishing 3 consecutive successful intubations with both LMAs on manikin, each participant applied intubation with both LMAs in random order for initial evaluation. To evaluate skill retention, participants were reassessed 90 days later on the same manikin without retraining between times. Primary outcome was time to successful ventilation (TTV).
The TTV for i-gel was significantly shorter than Aura-i (initial evaluation 11.8 ± 2.9 seconds vs 22.4 ± 5.2 seconds, 90-days reevaluation 14.9 ± 3.6 seconds vs 28.9 ± 10.0 seconds, initial evaluation, P = .001; second evaluation, P < .001); during re-evaluation, TTV taken for i-gel and Aura-i were both significantly longer (initial evaluation, P = .001; second evaluation, P < .001) and ease score of insertion both increased profoundly (i-gel P = .025; Aura-i P < .001). In both assessments, participants preferred i-gel as easier alternative (initial evaluation, P = .001; second evaluation, P < .001). There was no difference in successful intubation rate, first attempt success rate, bronchoscopy assessment, and insertion score for 2 LMAs.
Compared with Aura-i, i-gel showed a faster and easier intubation by novice doctors in this manikin study; the skill retention of intubation performance after 3 months was acceptable for both intubating LMAs, but TTV prolonged significantly.
可弯曲喉罩气道（LMA），如i-gel和Aura-i，可作为复苏中的抢救设备，并通过在不中断通气的情况下促进气管插管进一步确保气道安全。但关于新手使用可弯曲喉罩气道的数据有限，且未评估未经定期训练时技能的衰退情况。因此，我们设计了这项前瞻性随机交叉模拟人研究，以比较两种可弯曲喉罩气道（i-gel和Aura-i）的学习效果。
共有46名新手医生参与本研究。在标准化培训并在模拟人上连续3次成功使用两种喉罩气道完成插管后，每位参与者以随机顺序使用两种喉罩气道进行插管以进行初始评估。为评估技能保留情况，90天后在同一模拟人上对参与者进行重新评估，期间不进行再培训。主要结局指标是成功通气时间（TTV）。
i-gel的TTV明显短于Aura-i（初始评估时为11.8±2.9秒对22.4±5.2秒，90天重新评估时为14.9±3.6秒对28.9±10.0秒，初始评估，P = 0.001；第二次评估，P < 0.001）；在重新评估期间，i-gel和Aura-i的TTV均显著延长（初始评估，P = 0.001；第二次评估，P < 0.001），且插入的简易程度评分均显著增加（i-gel，P = 0.025；Aura-i，P < 0.001）。在两项评估中，参与者均更倾向于选择i-gel作为更简易的选择（初始评估，P = 0.001；第二次评估，P < 0.001）。两种喉罩气道的成功插管率、首次尝试成功率、支气管镜评估及插入评分均无差异。
在本模拟人研究中，与Aura-i相比，新手医生使用i-gel插管更快且更简易；3个月后两种可弯曲喉罩气道的插管技能保留情况均可接受，但TTV显著延长。
