Soiled airway tracheal intubation and the effectiveness of decontamination by paramedics (SATIATED): a randomised controlled manikin study

Richard Pilbery, M Dawn Teare, Richard Pilbery, M Dawn Teare

Abstract

Introduction: Vomiting and regurgitation are commonly encountered in out-of-hospital cardiac arrest (OHCA), with a reported incidence of 20-30%. This is of concern since patients who have suffered an OHCA are already in extremis. If standard suctioning techniques are not sufficient to maintain a clear airway and provide ventilation, then these patients will die, irrespective of the quality of chest compressions and the timeliness of defibrillation. This study aimed to determine whether a short teaching session of the suction assisted laryngoscopy and airway decontamination (SALAD) technique improved paramedics' ability to successfully intubate a contaminated airway.

Methods: A modified airway manikin with the oesophagus connected to a reservoir of 'vomit', and a bilge pump capable of propelling the vomit up into the oropharynx, was used to simulate a soiled airway. The intervention consisted of a brief SALAD training session with a demonstration and opportunity to practice. Participants were randomly allocated into two groups: AAB, who made two pre-training intubation attempts and one post-training attempt, and ABB, who made one pre-training and two post-training attempts, to adjust for improvement in performance due to repetition.

Results: In this manikin study, following a brief SALAD training session, more paramedics were able to intubate a soiled airway on their first attempt, compared to those without training (90.2% vs. 53.7%, difference of 36.6%, 95% CI 24-49.1%, p < 0.001). In addition, the mean difference in time taken to perform a successful intubation between groups was statistically significant for attempts 1 and 2 (mean difference 11.71 seconds, 95% CI 1.95-21.47 seconds, p = 0.02), but not attempts 1 and 3 (mean difference -2.52 seconds, 95% CI -11.64-6.61 seconds, p = 0.58). This result is likely to be confounded by the use of tracheal suction, which only occurred in the post-training attempts and added additional time to the intubation attempts. There was no statistically significant difference in success rates on the third attempt between AAB and ABB (89.0% vs. 86.6%, difference 2.4%, 95% CI 7.6-12.4%, p = 0.63).

Conclusion: In this study, the use of the SALAD technique significantly improved first attempt success rates when paramedics were intubating a simulated soiled airway.

Keywords: airway obstruction; emergency medical services; intubation.

Conflict of interest statement

RP is editor-in-chief of the BPJ and an employee of Yorkshire Ambulance Service NHS Trust. MDT declares no conflict of interest.

© 2019 The Author(s).

Figures

Figure 1. SALAD manikin set-up used for…
Figure 1. SALAD manikin set-up used for the study.
Figure 2. Successful intubation attempt times, stratified…
Figure 2. Successful intubation attempt times, stratified by randomisation sequence and attempt number.
Figure 3. Techniques and omissions during intubation…
Figure 3. Techniques and omissions during intubation attempts, stratified by randomisation group, attempt number and intubation outcome.

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Source: PubMed

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