Comparison of Airway Management Methods in Entrapped Patients

A Manikin Study

Andrew B. Martin, Jim Lingg, Jeffrey Lubin

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Endotracheal intubation remains one of the most challenging skills in prehospital care. There is a minimal amount of data on the optimal technique to use when managing the airway of an entrapped patient. We hypothesized that use of a blindly placed device would result in both the shortest time to airway management and highest success rate. Methods: A difficult airway manikin was placed in a cervical collar and secured upside down in an overturned vehicle. Experienced paramedics and prehospital registered nurses used four different methods to secure the airway: direct laryngoscopy, digital intubation, King LT-D, and CMAC video laryngoscopy. Each participant was given three opportunities to secure the airway using each technique in random order. A study investigator timed each attempt and confirmed successful placement, which was determined upon inflation of the manikin's lungs. Intubation success rates were analyzed using a general estimating equations model to account for repeated measures and a linear mixed effects model for average time. Results: Twenty-two prehospital providers participated in the study. The one-pass success rate for the King LT-D was significantly higher than direct laryngoscopy (OR 0.048, CI 0.006–0.351, p < 0.01) and digital intubation (OR 0.040, CI 0.005–0.297, p < 0.01). However, there was no statistical difference between the one-pass success rate of the King LT-D and CMAC video laryngoscopy (OR 0.302, 95% CI 0.026–3.44, p = 0.33). The one-pass median placement time of the King LT-D (22 seconds, IQR 17–26) was significantly lower (p < 0.001) than direct laryngoscopy (60 seconds, IQR 42–75), digital intubation (38 seconds, IQR 26–74), and the CMAC (51 seconds, IQR 43–76). Conclusions: In this study, while the King LT-D offered the quickest airway placement, success rates were not significantly greater than intubation using the CMAC video laryngoscope. Intubation using direct laryngoscopy and digital intubation were less successful and took more time. Use of a blindly placed device or a video laryngoscope may provide the best avenues for airway management of entrapped patients.

Original languageEnglish (US)
Pages (from-to)657-661
Number of pages5
JournalPrehospital Emergency Care
Volume20
Issue number5
DOIs
StatePublished - Sep 2 2016

Fingerprint

Manikins
Airway Management
Laryngoscopy
Intubation
Laryngoscopes
Equipment and Supplies
Allied Health Personnel
Intratracheal Intubation
Economic Inflation
Nurses
Research Personnel
Lung

All Science Journal Classification (ASJC) codes

  • Emergency Medicine
  • Emergency

Cite this

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title = "Comparison of Airway Management Methods in Entrapped Patients: A Manikin Study",
abstract = "Introduction: Endotracheal intubation remains one of the most challenging skills in prehospital care. There is a minimal amount of data on the optimal technique to use when managing the airway of an entrapped patient. We hypothesized that use of a blindly placed device would result in both the shortest time to airway management and highest success rate. Methods: A difficult airway manikin was placed in a cervical collar and secured upside down in an overturned vehicle. Experienced paramedics and prehospital registered nurses used four different methods to secure the airway: direct laryngoscopy, digital intubation, King LT-D, and CMAC video laryngoscopy. Each participant was given three opportunities to secure the airway using each technique in random order. A study investigator timed each attempt and confirmed successful placement, which was determined upon inflation of the manikin's lungs. Intubation success rates were analyzed using a general estimating equations model to account for repeated measures and a linear mixed effects model for average time. Results: Twenty-two prehospital providers participated in the study. The one-pass success rate for the King LT-D was significantly higher than direct laryngoscopy (OR 0.048, CI 0.006–0.351, p < 0.01) and digital intubation (OR 0.040, CI 0.005–0.297, p < 0.01). However, there was no statistical difference between the one-pass success rate of the King LT-D and CMAC video laryngoscopy (OR 0.302, 95{\%} CI 0.026–3.44, p = 0.33). The one-pass median placement time of the King LT-D (22 seconds, IQR 17–26) was significantly lower (p < 0.001) than direct laryngoscopy (60 seconds, IQR 42–75), digital intubation (38 seconds, IQR 26–74), and the CMAC (51 seconds, IQR 43–76). Conclusions: In this study, while the King LT-D offered the quickest airway placement, success rates were not significantly greater than intubation using the CMAC video laryngoscope. Intubation using direct laryngoscopy and digital intubation were less successful and took more time. Use of a blindly placed device or a video laryngoscope may provide the best avenues for airway management of entrapped patients.",
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Comparison of Airway Management Methods in Entrapped Patients : A Manikin Study. / Martin, Andrew B.; Lingg, Jim; Lubin, Jeffrey.

In: Prehospital Emergency Care, Vol. 20, No. 5, 02.09.2016, p. 657-661.

Research output: Contribution to journalArticle

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AB - Introduction: Endotracheal intubation remains one of the most challenging skills in prehospital care. There is a minimal amount of data on the optimal technique to use when managing the airway of an entrapped patient. We hypothesized that use of a blindly placed device would result in both the shortest time to airway management and highest success rate. Methods: A difficult airway manikin was placed in a cervical collar and secured upside down in an overturned vehicle. Experienced paramedics and prehospital registered nurses used four different methods to secure the airway: direct laryngoscopy, digital intubation, King LT-D, and CMAC video laryngoscopy. Each participant was given three opportunities to secure the airway using each technique in random order. A study investigator timed each attempt and confirmed successful placement, which was determined upon inflation of the manikin's lungs. Intubation success rates were analyzed using a general estimating equations model to account for repeated measures and a linear mixed effects model for average time. Results: Twenty-two prehospital providers participated in the study. The one-pass success rate for the King LT-D was significantly higher than direct laryngoscopy (OR 0.048, CI 0.006–0.351, p < 0.01) and digital intubation (OR 0.040, CI 0.005–0.297, p < 0.01). However, there was no statistical difference between the one-pass success rate of the King LT-D and CMAC video laryngoscopy (OR 0.302, 95% CI 0.026–3.44, p = 0.33). The one-pass median placement time of the King LT-D (22 seconds, IQR 17–26) was significantly lower (p < 0.001) than direct laryngoscopy (60 seconds, IQR 42–75), digital intubation (38 seconds, IQR 26–74), and the CMAC (51 seconds, IQR 43–76). Conclusions: In this study, while the King LT-D offered the quickest airway placement, success rates were not significantly greater than intubation using the CMAC video laryngoscope. Intubation using direct laryngoscopy and digital intubation were less successful and took more time. Use of a blindly placed device or a video laryngoscope may provide the best avenues for airway management of entrapped patients.

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