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[院外急救中使用声门外气道的技能保持:基于模拟器的医学教育的效果和长期结果:一项前瞻性随访研究]

[Skill retention using extraglottic airways in out-of-hospital emergencies: efficacy and long-term results of simulator-based medical education : A prospective follow-up study].

作者信息

Mann V, Limberg F, Mann S T W, Little S, Müller M, Sander M, Röhrig R

机构信息

Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35385, Gießen, Deutschland.

Klinik für Orthopädie, Zentralklinik Bad Berka, Bad Berka, Deutschland.

出版信息

Med Klin Intensivmed Notfmed. 2019 Sep;114(6):541-551. doi: 10.1007/s00063-018-0429-7. Epub 2018 Apr 11.

DOI:10.1007/s00063-018-0429-7
PMID:29644401
Abstract

OBJECTIVE

For emergency medicine personnel (EMP), there is little evidence concerning the adequate timing for refresher courses to maintain routine in the application of extraglottic airways. The aim of this study was to evaluate the efficacy and long-term results of a simulator-based education concept teaching the basic airway management skills with extraglottic airways for EMP and also to draw conclusions concerning the adequate time interval for refresher courses.

METHODS

By use of an explorative, prospective simulator-study with nonphysician EMP, airway management skills using the Larynxmaske Supreme® (LMA‑S) after an introduction lecture were examined. The application of an endotracheal tube (ETT) served as control. Time for preparation of the airway devices, insertion success, and resulting apnea time were assessed immediately after the first introduction lecture (t1) and unannounced 9-12 months thereafter (t2).

RESULTS

Comparison of the times for preparation of the LMA‑S at t1 and t2 demonstrated similar results. After the introduction lecture, all paramedics were able to insert the LMA‑S successfully after maximal 2 attempts; 9-12 months later success rates with the LMA‑S were unchanged. Apnea time during airway management was shorter with the LMA‑S compared to the ETT (p < 0.01). Times needed for preparation of the airway devices were similar.

CONCLUSION

The results of this simulator study indicate that a standardized introduction lecture is appropriate to ensure long-lasting procedural skills up to 12 months, so that subsequent refresher courses in basic airway management with the LMA‑S once a year may be adequate. A simulator-based education in basic airway management skills with extraglottic airways is recommended for facilitation of further clinical education according to the current guidelines.

摘要

目的

对于急诊医学人员而言,关于声门上气道应用的定期进修课程的合适时间安排,几乎没有相关证据。本研究的目的是评估一种基于模拟器的教育理念的效果和长期结果,该理念教授急诊医学人员使用声门上气道的基本气道管理技能,并就进修课程的合适时间间隔得出结论。

方法

通过对非医师急诊医学人员进行探索性、前瞻性模拟器研究,在入门讲座后检查使用Larynxmaske Supreme®(LMA-S)的气道管理技能。应用气管内插管(ETT)作为对照。在首次入门讲座后立即(t1)以及此后9至12个月未通知的情况下(t2),评估气道装置准备时间、插入成功率和由此产生的呼吸暂停时间。

结果

比较t₁和t₂时LMA-S的准备时间,结果相似。入门讲座后,所有护理人员最多尝试2次就能成功插入LMA-S;9至12个月后,LMA-S的成功率不变。与ETT相比,使用LMA-S进行气道管理时的呼吸暂停时间更短(p<0.01)。气道装置准备所需时间相似。

结论

该模拟器研究结果表明,标准化的入门讲座足以确保长达12个月的持久操作技能,因此每年进行一次后续的LMA-S基本气道管理进修课程可能就足够了。建议根据当前指南,开展基于模拟器的声门上气道基本气道管理技能教育,以促进进一步的临床教育。

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Insertion Success of the Laryngeal Tube in Emergency Airway Management.喉罩在紧急气道管理中的置入成功率。
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Which supraglottic airway will serve my patient best?哪种声门上气道对我的患者最为适用?
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Complications associated with the prehospital use of laryngeal tubes--a systematic analysis of risk factors and strategies for prevention.院前使用喉罩相关并发症——危险因素及预防策略的系统分析
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