The suction-assisted laryngoscopy assisted decontamination technique toward successful intubation during massive vomiting simulation: A pilot before-after study

Li-Wei Lin, Chi-Chieh Huang, Jiann Ruey Ong, Chee-Fah Chong, Nai-Yuan Wu, Shih-Wen Hung, Li-Wei Lin, Chi-Chieh Huang, Jiann Ruey Ong, Chee-Fah Chong, Nai-Yuan Wu, Shih-Wen Hung

Abstract

This study demonstrated a training program of the suction-assisted laryngoscopy assisted decontamination (S.A.L.A.D.) technique for emergency medical technician paramedic (EMT-P). The effectiveness of the training program on the improvements of skills and confidence in managing soiled airway was evaluated.In this pilot before-after study, 41 EMT-P participated in a training program which consisted of 1 training course and 3 evaluation scenarios. The training course included lectures, demonstration, and practice and focused on how to perform endotracheal intubation in soiled airway with the S.A.L.A.D technique. The first scenario was performed on standard airway mannequin head with clean airway (control scenario). The second scenario (pre-training scenario) and the third scenario (post-training scenario) were performed in airway with simulated massive vomiting. The post-training scenario was applied immediately after the training course. All trainees were requested to perform endotracheal intubation for 3 times in each scenario. The "pass" of a scenario was defined as more than twice successful intubation in a scenario. The intubation time, count of successful intubation, pass rate, and the confidence in endotracheal intubation were evaluated.The intubation time in the post-training scenario was significantly shorter than that in the pre-training scenario (P = .031). The pass rate of the control, pre-training, and post-training scenario was 100%, 82.9%, and 92.7%, respectively. The proportion of trainees reporting confident or very confident in endotracheal intubation in soiled airway increased from 22.0% to 97.6% after the training program. Kaplan-Meier analysis revealed that the adjusted hazard ratio of successful intubation for post-training versus pre-training scenario was 2.13 (95% confidence interval of 1.57-2.91).The S.A.L.A.D. technique training could efficiently help EMT-P performing endotracheal intubation during massive vomiting simulation.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
(A) The intubation time in each scenario. (B) The intubation time in the post-training scenario by the results of the pre-training scenario.
Figure 2
Figure 2
Kaplan–Meier curve of successful intubation in the pre-training and post-training scenario.

References

    1. Kleinman ME, Goldberger ZD, Rea T, et al. 2017 American Heart Association Focused Update on adult basic life support and cardiopulmonary resuscitation quality: an update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2018;137:e7–13.
    1. Perkins GD, Olasveengen TM, Maconochie I, et al. European Resuscitation Council Guidelines for Resuscitation: 2017 update. Resuscitation 2018;123:43–50.
    1. Wang HE, Szydlo D, Stouffer JA, et al. Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest. Resuscitation 2012;83:1061–6.
    1. Kovacs G, Sowers N. Airway management in trauma. Emerg Med Clin North Am 2018;36:61–84.
    1. Gaither JB, Spaite DW, Stolz U, et al. Prevalence of difficult airway predictors in cases of failed prehospital endotracheal intubation. J Emerg Med 2014;47:294–300.
    1. Simons RW, Rea TD, Becker LJ, et al. The incidence and significance of emesis associated with out-of-hospital cardiac arrest. Resuscitation 2007;74:427–31.
    1. Widmeier K, Wesley K. Infection inspection: screening & managing sepsis in the prehospital setting, part 2 of 2. JEMS 2014;39:36–40.
    1. Jost D, Minh PD, Galinou N, et al. What is the incidence of regurgitation during an out-of-hospital cardiac arrest? Observational study. Resuscitation 2015;96suppl:70.
    1. Carlson JN, Wang HE. Paramedic intubation: does practice make perfect? Ann Emerg Med 2017;70:391–3.
    1. DuCanto J, Serrano KD, Thompson RJ. Novel airway training tool that simulates vomiting: suction-assisted laryngoscopy assisted decontamination (SALAD) system. West J Emerg Med 2017;18:117–20.
    1. Ohchi F, Komasawa N, Mihara R, et al. Evaluation of gum-elastic bougie combined with direct and indirect laryngoscopes in vomitus setting: A randomized simulation trial. Am J Emerg Med 2017;35:584–8.
    1. Hasegawa K, Shigemitsu K, Hagiwara Y, et al. Association between repeated intubation attempts and adverse events in emergency departments: an analysis of a multicenter prospective observational study. Ann Emerg Med 2012;60:749.e2–54.e2.
    1. Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg 2004;99:607–13. table of contents.
    1. Sakles JC, Chiu S, Mosier J, et al. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med 2013;20:71–8.
    1. Burns B, Habig K, Eason H, et al. Difficult intubation factors in prehospital rapid sequence intubation by an australian helicopter emergency medical service. Air Med J 2016;35:28–32.
    1. Gerecht R, Brainard C. Overview of prehospital airway suctioning. JEMS 2015;40:1–9.
    1. Kang K, Kim T, Ro YS, et al. Prehospital endotracheal intubation and survival after out-of-hospital cardiac arrest: results from the Korean nationwide registry. Am J Emerg Med 2016;34:128–32.
    1. Shin SD, Ong ME, Tanaka H, et al. Comparison of emergency medical services systems across Pan-Asian countries: a Web-based survey. Prehosp Emerg Care 2012;16:477–96.
    1. Wang HE, Mann NC, Mears G, et al. Out-of-hospital airway management in the United States. Resuscitation 2011;82:378–85.
    1. Fouche PF, Simpson PM, Bendall J, et al. Airways in out-of-hospital cardiac arrest: systematic review and meta-analysis. Prehosp Emerg Care 2014;18:244–56.
    1. Hasegawa K, Hiraide A, Chang Y, et al. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA 2013;309:257–66.
    1. Izawa J, Iwami T, Gibo K, et al. Timing of advanced airway management by emergency medical services personnel following out-of-hospital cardiac arrest: a population-based cohort study. Resuscitation 2018;128:16–23.
    1. Jabre P, Penaloza A, Pinero D, et al. Effect of bag-mask ventilation vs endotracheal intubation during cardiopulmonary resuscitation on neurological outcome after Out-of-Hospital cardiorespiratory arrest: a randomized clinical trial. JAMA 2018;319:779–87.
    1. Knight BH. The significance of the postmortem discovery of gastric contents in the air passages. Forensic Sci 1975;6:229–34.
    1. Piegeler T, Roessler B, Goliasch G, et al. Evaluation of six different airway devices regarding regurgitation and pulmonary aspiration during cardio-pulmonary resuscitation (CPR) - a human cadaver pilot study. Resuscitation 2016;102:70–4.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅