Bernhard Roessler

Performance and skill retention of intubation by paramedics using seven different airway devices—A manikin study

INTRODUCTION Endotracheal intubation (ETI) is the most widespread method for emergency airway management. Several studies reported that ETI requires considerable skill and experience and if performed incorrectly, may result in serious adverse events. Unrecognized tube misplacement or oesophageal intubation is associated with high prehospital morbidity. This study investigates the usability of supraglottic airway devices compared to ETI and the skill retention of 41 previously inexperienced paramedics following training using a manikin model. METHODS 41 paramedics participated in this study. None had prior experience in airway management, apart from bag-valve ventilation. After a standardised audio-visual lecture lasting 45min, the paramedics participated in a practical demonstration using the advanced patient simulator SimMan(®) (Laerdal Medical, Stavanger, Norway). Afterwards, paramedics were instructed to perform airway-management using seven different techniques to secure the airway (ETI, Laryngeal mask unique [LMA], Proseal, Laryngeal tube disposable [LT-D(®)], I-Gel(®), Combitube(®), and EasyTube(®)) following a randomized sequence. Participants underwent reassessment after 3 months without any further training or practice in airway-management. RESULTS During the initial training session, ETI was successfully performed in 78% of cases, while 3 months later the success rate was 58%. For the supraglottic airway devices, five out of six were successfully used by all paramedics at both time points, the exception being Proseal(®). Our data show successful skill retention (success rate: 100%) after 3 months for five out of six supraglottic airway devices. Time to ventilation (T3) was significantly less for LMA, LT-D(®) and I-Gel(®) at all time points compared to ETI. CONCLUSION ETI performed by inexperienced paramedics is associated with a low success rate. In contrast, supraglottic airway devices like LMA, LT-D(®), I-Gel(®), Combitube(®) and EasyTube(®) are fast, safe and easy-to-use. Within the limitations of a manikin-study, this study suggests that inexperienced medical staff might benefit from using supraglottic airway devices for emergency airway management.

Hands-off time during insertion of six airway devices during cardiopulmonary resuscitation: A randomised manikin trial

INTRODUCTION Cardiopulmonary resuscitation (CPR) guidelines recommend limiting interruptions of chest compressions because prolonged hands-off (i.e., non-compression) time compromises tissue perfusion. 2010 European Resuscitation Council guidelines suggest that chest compressions should be paused less than 10 s during airway device insertion. METHODS With approval of the local ethics committee of the Medical University of Vienna and written informed consent, we recruited 40 voluntary emergency medical technicians, none of whom had advanced airway management experience. After a standardised audio-visual lecture and practical demonstration, technicians performed airway management with each six airway devices (endotracheal tube, Combitube, EasyTube, laryngeal tube, Laryngeal Mask Airway, and I-Gel) during on-going chest compressions in a randomised sequence on a Resusci Anne Advanced Simulator. Data were analysed using a mixed-effects model accounting for the repeated measurements and pair-wise comparisons among the airway devices. RESULTS The hands-off time associated with airway management using an endotracheal tube (including all intubation attempts) was 48 s (95% confidence interval: 43-53). The hands-off time for airway management using a laryngeal tube was 8.4 (3.4-16.4) s, Combitube 10.0 (4.9-15.1) s, EasyTube 11.4 (6.4-16.4) s, LMA 13.3 (8.2-18.3) s and for I-Gel 15.9 (10.8-20.9) s. Hands-off time was significantly longer with the conventional endotracheal tube than with any of the other airway systems. Only a third of the technicians successfully inserted an endotracheal tube whereas all of them successfully positioned each supraglottic device. CONCLUSION Supraglottic devices appear to be a reasonable emergency airway management strategy, even for inexperienced personnel.

Cardiopulmonary resuscitation and the 2005 universal algorithm: Has the quality of CPR improved?

ZusammenfassungHINTERGRUND: Eine optimale Herz-Druck-Massage stellt die Grundlage jeder erfolgreichen Reanimation dar. Das ideale Verhältnis von Thoraxkompressionen zu Atemspenden ist weiterhin Gegenstand von Untersuchungen, die Wichtigkeit des sofortigen Beginnes einer ausreichend tiefen Herzdruckmassage nach Eintreten des Herzkreislaufstillstandes sowie die Reduktion von Unterbrechungen der Herzdruckmassage ist jedoch eindeutig bewiesen. Im Jahr 2005 wurden die Richtlinien für Basisreanimationsmaßnahmen durch das European Resuscitation Council grundlegend verändert. Ziel war es, Unterbrechungen der Herz-Druck-Massage zu minimieren. Im Rahmen der vorliegenden Studie wurden Ersthelferreanimationen am Übungsphantom nach den Richtlinien 2000 mit jenen von 2005 verglichen. METHODEN: Nach positivem Votum der Ethikkommission wurde die Studie im randomisierten cross-over Design durchgeführt. Teilnehmer wurden nach einer jeweils zehn Minuten dauernden Unterrichts- und Übungsperiode aufgefordert, fünf Minuten Basisreanimation am Übungsphantom durchzuführen. Endpunkte der Studie waren die hands-off-Zeit (Zeit im Herzkreislaufstillstand ohne Herzdruckmassage) sowie Gesamtzahl der Thoraxkompressionen. ERGEBNIS: Fünfzig Probanden wurden eingeschlossen, eine Probandin zog sich nach der Randomisierung aus der Studie zurück. Die hands-off-Zeit war unter den Reanimationsrichtlinien 2005 signifikant kürzer als unter den Richtlinien 2000 (MW ± SD: 107 ± 19 sec vs. 139 ± 15 sec.; p < 0.0001). Weiters war auch die Gesamtzahl der Thoraxkompressionen unter den Reanimationsrichtlinien 2005 gegenüber den Richtlinien 2000 signifikant verbessert (347 ± 64 vs. 233 ± 51 Kompressionen; p < 0.0001). SCHLUSSFOLGERUNG: Basisreanimation nach den Richtlinien 2005 zeigte am Übungsphantom eine signifikante Verbesserung wesentlicher Qualitätsparameter der Herz-Lungen Wiederbelebung.SummaryBACKGROUND AND AIM: Chest compressions are crucial in cardiopulmonary resuscitation (CPR), although the optimal number, rate and sequence are unknown. The 2005 CPR guidelines of the European Resuscitation Council (ERC) brought major changes to the basic life support algorithm. One of the major aims of the ERC was to decrease hands-off time in order to improve perfusion of the coronary vessels and the brain. Using a manikin model of basic life support in simulated cardiac arrest, we compared hands-off time and total number of chest compressions according to the guidelines of 2000 and those of 2005. METHODS: A total of 50 volunteers performed CPR according to the guidelines of 2000 (Group 2000) and 2005 (Group 2005) in a randomized unblinded cross-over study. Volunteers received 10 min of standardized teaching and 10 min of training, including corrective feedback, for each set of guidelines before performing 5 min of basic life support on a manikin. We compared hands-off time as the primary outcome parameter and the total number of chest compressions as the secondary outcome parameter. RESULTS: Fifty volunteers were enrolled in the study, one individual dropped out after randomization. In Group 2005, hands-off time was significantly lower (mean 107 ± 19 [SD] s vs. 139 ± 15 s in Group 2000 (P < 0.0001) and the total number of chest compressions was significantly higher (347 ± 64 compressions vs. 233 ± 51 compressions; P < 0.0001). CONCLUSION: In this manikin setting, both hands-off time and the total number of chest compressions improved with basic life support performed according to the ERC guidelines of 2005.

Automated external defibrillators do not recommend false positive shocks under the influence of electromagnetic fields present at public locations.

Electromagnetic fields (EMF) reduce the signal quality of electrocardiograms and may lead to the misinterpretation by automated external defibrillators (AED). We designed this investigation as a prospective study, with a randomized sequence of AED applications on healthy volunteers. We chose busy public places where public access defibrillation was possible as test locations. Strong EMF were sought and found at train stations next to accelerating and decelerating trains. The primary outcome variable was the absolute number of shocks advised in the presence of sinus rhythm by five commonly used AED in Austria. For data analysis, the statistician was blinded in regard to the AED models tested. Data analysis was based on a per protocol evaluation. Of 390 tests run, 0 cases of false positive results occurred (95% CI: 0–0.77). AED can be regarded as safe, even with the interference of EMF present at train stations.