Airway management in the adult prehospital medicine – to tube or not to tube?

Česká verzia

Authors: O. Klementová ¹; T. Henlín ^2,3; M. Szkorupa ⁴; P. Michálek ^5,6
Authors place of work: Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice, Olomouc ¹; Klinika anesteziologie, resuscitace a intenzivní medicíny, Vojenská fakultní nemocnice, Praha ²; Odbor letecké záchranné služby a urgentní medicíny AČR Líně, Plzeň ³; 1. chirurgická klinika, Fakultní nemocnice, Olomouc ⁴; Klinika anesteziologie, resuscitace a intenzivní medicíny, 1. LF UK a Všeobecná fakultní nemocnice, Praha ⁵; Department of Anaesthesia and Intensive Medicine, Antrim Area Hospital, Antrim, Spojené království ⁶
Published in the journal: Anest. intenziv. Med., 31, 2020, č. 1-2, s. 6-12
Category:

Summary

Adequate oxygenation and maintaining the patent airway are one of the key factors for patient survival in prehospital care. The main difference against the operating room is the environment of the accident and experience with the qualification of the provider. Basic techniques include the use of manual maneuvers for opening the airway, bag-mask ventilation, and insertion of the oropharyngeal or nasopharyngeal airways. Advanced techniques involve the insertion of a supraglottic airway device and tracheal intubation. Surgical cricothyrotomy is indicated only in a small number of patients and in the battlefield medicine. Tracheal intubation still remains a method of choice when performed by experience provider, for the unconscious victims and resuscitation in out-of-hospital cardiac arrest. Special tools such as gum elastic bougie or videolaryngoscopes are employed to increase the success rate of out of hospital tracheal intubation. Supraglottic airway devices inserted in prehospital care include laryngeal mask airways, i-gel, and laryngeal tube.

Keywords:

tracheal intubation – supraglottic airway device – cricothyrotomy – prehospital care

Zdroje

1. Jacobs PE, Grabinsky A. Advances in prehospital airway management. Int J Crit Illn Inj Sci 2014; 4: 57–64.

2. Sunde GA, Kottmann A, Heltne JK, Sandberg M, Gellerfors M, Krűger A, et al. Standardised data reporting from pre‑hospital advanced airway management – a nominal group technique update of the Utsteinstyle airway template. Scand J Trauma Resusc Emerg Med 2018; 26: 46.

3. Bosch J, de Nooij J, de Visser M, Cannegieter SC, Terpstra NJ, Heringhaus C, et al. Prehospital use in emergency patients of a laryngeal mask airway by ambulance paramedics is a safe and effective alternative for endotracheal intubation. Emerg Med J 2014; 31: 750–753.

4. Merelman A, Levitan R. A modern approach to basic airway management. J Emerg Med Serv 2018; 43: 4.

5. Fiala A, Lederer W, Neumayr A, Egger T, Neururer S, Toferer E, et al. EMT‑led laryngeal tube vs. face mask ventilation during cardiopulmonary resuscitation – multicenter prospective randomized trial. Scand J Trauma Resusc Emerg Med 2017; 25: 104.

6. Jabre P, Penaloza A, Pinero D, Duchateau FX, Borron SW, Javaudin F, et al. Effect of bag mask ventilation vs endotracheal intubation during cardiopulmonary resuscitation on neurological outcome after outof‑hospital cardiorespiratory arrest. JAMA 2018; 319: 779–787.

7. Butler FK. TCCC updates: two decades of saving lives on the battlefield: Tactical Combat Casualty Care turns 20. J Spec Oper Med 2017; 17: 166–172.

8. Berry AM, Brimacombe JR, Verghese C. The laryngeal mask airway in emergency medicine, neonatal resuscitation, and intensive care medicine. Int Anesthesiol Clin 1998; 36: 91–109.

9. Henlin T, Sotak M, Kovaricek P, Tyll T, Balcarek L, Michalek P. Comparison of five 2nd generation supraglottic airway devices for airway management performed by novice military operators. Biomed Res Int 2015; 2015: 201898.

10. Benger J, Coates D, Davies S, Greenwood R, Nolan J, Rhys M, et al. Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i‑gel and current practice in the initial airway management of out of hospital cardiac arrest: a feasibility study. Br J Anaesth 2016; 116: 262–268.

11. Michalek P, Miller DM. Airway management evolution – in a search for an ideal supraglottic airway device. Prague Med Rep 2014; 115: 87–103.

12. Benger JR, Kirby K, Black S, Brett SJ, Clout M, Lazaroo MJ, et al. Effect of a strategy of a supraglottic airway device vs tracheal intubation during out‑of‑hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomized clinical trial. JAMA 2018; 320: 779–791.

13. Crewdson K, Lockey DJ, Roislien R, Lossius HM, Rehn M. The success of pre‑hospital tracheal intubation by different pre‑hospital providers: a systematic literature review and meta‑analysis. Crit Care 2017; 21: 31.

14. Fouche PF, Stein C, Simpson P, Carlson JN, Doi SA. Nonphysician out‑of‑hospital rapid sequence intubation success and adverse events: a systematic review and meta‑analysis. Ann Emerg Med 2017; 70: 449–459.

15. Zdravkovic M, Berger‑Estilita J, Sorbello M, Hagberg CA. An international survey about rapid sequence intubation of 10.003 anaesthetists and 16 airway experts. Anaesthesia 2020; 75: 313–322.

16. Combes X, Jabre P, Margenet A, Merle JC, Leroux B. Unanticipated difficult airway management in the prehospital emergency setting: prospective validation of an algorithm. Anesthesiology 2011; 114: 105–110.

17. Brožek T, Michálek P. Role videolaryngoskopie v perioperační medicíně. Anest intenziv Med 2018; 29: 96–106.

18. Pepe PE, Roppolo LP, Fowler RL. Prehospital endotracheal intubation: elemental or detrimental. Crit Care 2015; 19: 121.

19. Calkins TR, Miller K, Langdorf MI. Success and complication rates with prehospital placement of an esophageal‑tracheal combitube as a rescue airway. Prehosp Disaster Med 2006; 21: 97–100.

20. Wang HE, Mann NC, Mears G, Jacobson K, Yealy DM. Out‑of‑hospital airway management in the United States. Resuscitation 2011; 82: 378–385.

21. Collopy KT, Kivlehan SM, Snyder SR. Surgical cricothyrotomies in prehospital care. EMS World 2015; 44: 42–49.

22. Otáhal M, Michálek P. Urgentní infraglotické zajištění dýchacích cest – koniopunkce, koniostomie, BACT. Anest intenziv Med 2018; 29: 158–165.

23. Henlin T, Michalek P, Tyll T, Ryska O. A randomized comparison of bougie‑assisted and TracheoQuick Plus cricothyrotomies on a live porcine model. BioMed Res Int 2017; 2017: 4215159.

24. Trimmel H, Beywinkler C, Hornung S, Kreutziger J, Voelckel WG. Success rates of pre hospital difficult airway management: a quality control study evaluating an in‑hospital training program. Int J Emerg Med 2018; 11: 19.

25. Soar J, Nolan JP, Bottiger BW, Perkins GD, Lott C, Carli P, et al. European Resuscitation Council guidelines for resuscitation 2015. Section 3. Adult advanced life support. Resuscitation 2015; 95: 100–147.

26. Henlin T, Michalek P, Tyll T, Hinds JD, Dobias M. Oxygenation, ventilation and airway management in out‑of‑hospital cardiac arrest: a review. BioMed Res Int 2014; 2014: 376871.

27. Tanabe S, Ogawa T, Akahane M, Koike S, Horiguchi H, Yasunaga H, et al. Comparison of neurological outcome between tracheal intubation and supraglottic device airway insertion of out‑of‑hospital cardiac arrest patients: a nationwide, population‑based, observational study. J Emerg Med 2013; 44: 389–397.

28. Kajino K, Iwami T, Kitamura T, Daya M, Ong ME, Nischiuchi T, el al. Comparison of supraglottic airway versus endotracheal intubation for the prehospital treatment of out‑of hospital cardiac arrest. Crit Care 2011; 15: R236.

29. Shin SD, Ahn KO, Song KJ, Park CB, Lee EJ. Out of hospital airway management and cardiac arrest outcomes: a propensity score matched analysis. Resuscitation 2012; 83: 313–319.

30. Wang HE, Schmicker RH, Daya MR, Stephens SW, Idris AH, Carlson JN, et al. Effect of a strategy of initial laryngeal tube insertion vs endotracheal intubation on 72-hour survival in adults with out‑of‑hospital cardiac arrest. JAMA 2018; 320: 769–778.

31. Fevang E, Perkins Z, Lockey D, Jeppesen E, Lossius HM. A systematic review and meta analysis comparing mortality in pre‑hospital tracheal intubation to emergency department intubation in trauma patients. Crit Care 2017; 21: 192.

32. Wahlin RR, Nelson DW, Bellander BM, Svensson M, Helmy A, Thelin EP. Prehospital intubation and outcome in traumatic brain injury – assessing intervention efficacy in a modern trauma cohort. Front Neurol 2018; 9: 194.

33. Denninghoff KR, Nuno T, Pauls Q, Yeatts SD, Silbergleit R, Palesch YY, et al. Prehospital intubation is associated with favorable outcomes and lower mortality in ProTECT III. Prehosp Emerg Care 2017; 21: 539–544.

34. Choffat C, Delhumeau C, Fournier N, Schoettker P. Effect of pre‑hospital intubation in patients with severe traumatic brain injury on outcome: a prospective cohort study. J Clin Med 2019; 8: 470.

35. Prekker ME, Feemster LC, Hough CL, Carlbom D, Crothers K, Au DH, et al. The epidemiology and outcome of prehospital respiratory distress. Acad Emerg Med 2014; 21: 543–550.

36. Nielsen VM, Madsen J, Aasen A, Toft‑Petersen AP, Lubcke K, Rasmussen BS, et al. Prehospital treatment with continuous positive airway pressure in patients with acute respiratory failure: a regional observational study. Scand J Trauma Resusc Emerg Med 2016; 24: 121.

37. Hua A, Haight S, Hoffman R, Manini AF. Endotracheal intubation after acute drug overdoses: incidence, complications, and risk factors. J Emerg Med 2017; 52: 59–65.

38. Prekker ME, Kwok H, Shin J, Carlbom D, Grabinsky A, Rea TD. The process of prehospital airway management: challenges and solutions during paramedic endotracheal intubation. Crit Care Med 2014; 42: 1372–1378.