Polish Society of Disaster Medicine, Warsaw, Poland.
Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.
Eur J Pediatr. 2019 Jun;178(6):871-882. doi: 10.1007/s00431-019-03345-4. Epub 2019 Mar 22.
Endotracheal intubation is the gold standard for airway management. Supraglottic airway devices (SADs) are useful in airway abnormalities. SAD blind intubation enables airway management with better ventilation and a reduced risk of gastric content aspiration. The aim was to compare various SADs in blind intubation performed by inexperienced physicians in several pediatric airway scenarios. One hundred sixteen physicians with no previous experience with SAD performed blind endotracheal intubations with (1) iGEL, (2) Air-Q intubating laryngeal airway, and (3) Ambu AuraGain disposable laryngeal mask in a pediatric manikin in three airway scenarios: (A) normal airway without chest compressions, (B) normal airway with continuous chest compressions with the CORPULS CPR system, and (C) difficult airway with continuous chest compressions with the CORPULS CPR system. Intubation tube with 5.0 internal diameter was used for all blind intubation attempts. First intubation success rate, median time to SAD placement, time to endotracheal intubation with SAD, and ease to perform the intubation were investigated in this study. All these parameters were better or non-inferior for iGEL in all investigated scenarios.Conclusion: Our manikin study demonstrated that iGEL was the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios. What is Known: • For pediatric resuscitation, bag-mask ventilation is the first-line method for airway control and ventilation. • Endotracheal intubation is considered by many scientific societies the gold standard for airway management. • Supraglottic airway devices are particularly useful when bag-mask ventilation is difficult or impossible but can be also used for blind intubation. What is New: • The iGEL laryngeal mask turns out the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios. • It may be a reasonable first emergency blind intubation technique for inexperienced physicians in pediatric patients in normal airway with and without continuous chest compressions, as well as in difficult airway with continuous chest compressions.
气管插管是气道管理的金标准。 声门上气道装置（SAD）在气道异常时很有用。 SAD 盲插可实现更好的通气和降低胃内容物吸入风险的气道管理。 目的是比较几种儿科气道情况下经验不足的医生进行盲插时各种 SAD 的效果。 116 名没有使用 SAD 经验的医生在儿科模拟人上进行了三种气道情况的盲插：（A）无胸部按压的正常气道，（B）使用 CORPULS CPR 系统持续胸部按压的正常气道，（C）使用 CORPULS CPR 系统持续胸部按压的困难气道。 所有盲插尝试均使用 5.0 内径的插管管。 本研究中研究了首次插管成功率、SAD 放置的中位数时间、使用 SAD 进行气管插管的时间以及进行插管的难易程度。 在所有研究的情况下，iGEL 在所有这些参数上均优于或非劣于其他 SAD。 结论：我们的模拟人研究表明，在不同的儿科气道情况下，iGEL 是经验不足的医生进行盲插的最有效装置。 已知： • 在儿科复苏中，球囊面罩通气是气道控制和通气的一线方法。 • 许多科学协会认为气管插管是气道管理的金标准。 • 当球囊面罩通气困难或不可能时，声门上气道装置特别有用，但也可用于盲插。 新发现： • iGEL 喉罩是经验不足的医生在不同儿科气道情况下进行盲插的最有效装置。 • 在有和没有持续胸部按压的正常气道以及有持续胸部按压的困难气道中，对于经验不足的儿科患者，它可能是一种合理的首次紧急盲插技术。
