Feasibility of written instructions in airway management training of laryngeal tube

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Tom Silfvast³  Jouko Gorski⁴  Juha-Pekka Laakso²  Tapio Kettunen¹  Heikki Paakkonen¹  Jouni Kurola¹ 

[1] Division of Prehospital Emergency care, Emergency and Intensive Care, Kuopio University Hospital, PO Box 1777, FIN-70210 Kuopio, Finland;Arcada University of Applied Sciences, Jan-Magnus Janssonin aukio 1, FIN-00550 Helsinki, Finland;Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, PO Box 340, FIN-00029 Helsinki, Finland;Emergency Services College, PO Box 1122, FIN-70821 Kuopio, Finland

关键词: training;    laryngeal tube;    Airway management;   

Others  :  826941
DOI  :  10.1186/1757-7241-19-56

 received in 2011-06-30, accepted in 2011-10-10,  发布年份 2011

【 摘 要 】

Background

Airway management is of essential importance in emergency care. Training and skill retention of endotracheal intubation (ETI) - the technique considered as the "gold standard" -, poses a problem especially among care providers experiencing a low frequency of airway management situations. Therefore, alternative airway devices such as the laryngeal tube (LT) with potentially steeper learning curves have been developed and studied. Our aim was to evaluate in a manikin model the use of LT after no other training than written instructions only.

Methods

To evaluate the amount of training required to use the LT in a scenario of airway compromise, we assessed the feasibility of providing written instructions and pictures showing its use to 67 out- and in-hospital emergency care providers attending an Emergency Care conference. The majority of the participants were either nurses or firemen with a median of 5 years' history of work in emergency care.

Results

In this study 55% of all participants inserted the LT on the first attempt without additional instructions. An additional 42% required verbal instructions before successful insertion. Overall, 97% of the participants successfully inserted the LT with two attempts.

In logistic regression analysis, no relationship was detected between background variables (basic education, experience of emergency work, frequency of bag-valve-mask ventilation (BVM) and frequency of ETI) and successful insertion of the LT in less than 30 seconds, ability to maintain normoventilation (7 l/min) and need for further instructions during the test.

Conclusions

We found that in this pilot study majority of emergency care providers could insert LT with one or two attempts with written instructions, pictures and verbal instruction. This may provide an option to simplify the training of airway management with LT.

【 授权许可】

   
2011 Kurola et al; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Bradley JS, Billows GL, Olinger ML, Boha SP, Cordell WH, Nelson DR: Prehospital oral endotracheal intubation by rural basic emergency medical technicians. Ann Emerg Med 1998, 32:26-32.
• [2]Berlac P, Hyldmo PK, Kongstad P, Kurola J, Nakstad AR, Sandberg M, Scandinavian Society for Anesthesiology and Intensive Care Medicine: Pre-hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand 2008, 52:897-907.
• [3]Cummins RO, Austin D, Graves JR, Litwin PE, Pierce J: Ventilation skills of emergency medical technicians: a teaching challenge for emergency medicine. Ann Emerg Med 1986, 15:1187-1192.
• [4]Tiah L, Wong E, Chen MF, Sadarangani SP: Should there be a change in the teaching of airway management in the medical school curriculum? Resuscitation 2005, 64:87-91.
• [5]Asai T, Shingu K: The laryngeal tube. Br J Anaesth 2005, 95:729-736.
• [6]Ocker H, Wenzel V, Schmucker P, Steinfath M, Dörges V: A comparison of the laryngeal tube with the laryngeal mask airway during routine surgical procedures. Anesth Analg 2002, 95:1094-1097.
• [7]Wrobel M, Grundmann U, Wilhelm W, Wagner S, Larsen R: Laryngeal tube versus laryngeal mask airway in anaesthetised non-paralysed patients. A comparison of handling and postoperative morbidity Anaesthesist 2004, 53:702-708.
• [8]Kurola J, Harve H, Kettunen T, Laakso JP, Gorski J, Paakkonen H, Silfvast T: Airway management in cardiac arrest--comparison of the laryngeal tube, tracheal intubation and bag-valve mask ventilation in emergency medical training. Resuscitation 2004, 61:149-153.
• [9]Schalk R, Meininger D, Ruesseler M Oberndörfer D, Walcher F, Zacharowski K, Latasch L, Byhahn C: Emergency airway management in trauma patients using laryngeal tube suction. Prehosp Emerg Care 2011, 15:347-350.
• [10]Wiese CH, Semmel T, Müller JU, Bahr J, Ocker H, Graf BM: The use of the laryngeal tube disposable (LT-D) by paramedics during out-of-hospital resuscitation-an observational study concerning ERC guidelines 2005. Resuscitation 2009, 80:194-198.
• [11]Schalk R, Byhahn C, Fausel F, Egner A, Oberndörfer D, Walcher F, Latasch L: Out-of-hospital airway management by paramedics and emergency physicians using laryngeal tubes. Resuscitation 2010, 81:323-326.
• [12]Stiell IG, Wells GA, Field B Spaite DW, Nesbitt LP, De Maio VJ, Nichol G, Cousineau D, Blackburn J, Munkley D, Luinstra-Toohey L, Campeau T, Dagnone E, Lyver M, Ontario Prehospital Advanced Life Support Study Group: Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 2004, 12:647-656.
• [13]Ochs M, Davis D, Hoyt D, Bailey D, Marshall L, Rosen P: Paramedic-performed rapid sequence intubation of patients with severe head injuries. Ann Emerg Med 2002, 40:168-171.
• [14]Mort TC: Emergency tracheal intubation: Complications associated with repeated laryngoskopic attempts. Anesth Analg 2004, 99:607-613.
• [15]Wiese CH, Bartels U, Bergmann A, Bergmann I, Bahr J, Graf BM: Using a laryngeal tube during cardiac arrest reduces "no flow time" in a manikin study: a comparison between laryngeal tube and endotracheal tube. Wien Klin Wochenschr 2008, 120:217-223.
• [16]Ruetzler K, Roessler B, Potura L, Priemayr A, Robak O, Schuster E, Frass M: Performance and skill retention of intubation by paramedics using seven different airway devices--a manikin study. Resuscitation 2011, 82:593-597.
• [17]Nakstad AR, Sandberg M: Airway management in simulated restricted access to a patient--can manikin-based studies provide relevant data? Scand J Trauma Resusc Emerg Med 2011, 19:36. BioMed Central Full Text