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Effect of the laryngeal tube on the no-flow-time in a simulated two rescuer basic life support setting with inexperienced users

Auswirkung des Larynx-Tubus auf die No-Flow-Zeit in einem simulierten zwei-Helfer Basic Life Support Szenario mit unerfahrenen Anwendern

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Abstract

Introduction

Intubation with a laryngeal tube (LT) is a recommended alternative to endotracheal intubation during advanced life support (ALS). LT insertion is easy; therefore, it may also be an alternative to bag-mask ventilation (BMV) for untrained personnel performing basic life support (BLS). Data from manikin studies support the influence of LT on no-flow-time (NFT) during ALS.

Methods

We performed a prospective, randomized manikin study using a two-rescuer model to compare the effects of ventilation using a LT and BMV on NFT during BLS. Participants were trained in BMV and were inexperienced in the use of a LT.

Results

There was no significant difference in total NFT with the use of a LT and BMV (LT: mean 83.1 ± 37.3 s; BMV: mean 78.7 ± 24.5 s; p = 0.313), but we found significant differences in the progression of the scenario: in the BLS-scenario, the proportion of time spent performing chest compressions was higher when BMV was used compared to when a LT was used. The quality of chest compressions and the ventilation rate did not differ significantly between the two groups. The mean tidal volume and mean minute volume were significantly larger with the use of a LT compared with the use of BMV.

Conclusions

In conclusion, in a two-rescuer BLS scenario, NFT is longer with the use of a LT (without prior training) than with the use of BMV (with prior training). The probable reasons for this result are higher tidal volumes with the use of a LT leading to longer interruptions without chest compressions.

Zusammenfassung

Hintergrund

Der Larynx-Tubus (LT) ist eine empfohlene Alternative zur endotrachealen Intubation im Rahmen von erweiterten Reanimationsmaßnahmen (Advanced Life Support, ALS). Die Insertion des Devices ist einfach, daher ist sein Einsatz auch als Alternative zur Beutel-Masken-Beatmung (Beutel-Masken-Ventilation, BMV) für ungeübtes Personal im Rahmen von Basis-Reanimationsmaßnahmen (Basic Life Support, BLS) denkbar. Daten unterstützen zudem einen positiven Einfluss des LT auf die No-Flow-Time (NFT) beim ALS in Manikin-Studien.

Material und Methoden

Wir untersuchten den Einfluss des LT auf die NFT und die Qualität der Beatmung beim BLS im Vergleich zur BMV im Rahmen einer prospektiven, randomisierten Manikin-Studie im Zwei-Helfer-Modell. Die Probanden waren in BMV ausgebildet, jedoch unerfahren in der Anwendung eines LT.

Ergebnisse

Es zeigte sich kein signifikanter Unterschied in der absoluten NFT (LT: 83,1 ± 37,3 s; BMV: 78,7 ± 24,5 s; p = 0,313). Bei Betrachtung der späteren Zeitabschnitte des Reanimationsverlaufs zeigten sich signifikante Unterschiede: der zeitliche Anteil an Herzdruckmassage stieg unter BMV stetig an, während sich dieser bei Anwendung des LT verringerte. Die Qualität der Herzdruckmassage und die Beatmungsfrequenz unterschieden sich nicht signifikant. Die durchschnittlichen Tidalvolumina sowie Atemminutenvolumina zeigten sich deutlich größer bei Beatmung mit dem LT.

Schlussfolgerungen

Die Anwendung des LT durch ungeübtes Personal im Rahmen des BLS im Zwei-Helfer-Modell führt im Vergleich zur geübten BMV zu einer Verlängerung der NFT. Eine wahrscheinliche Erklärung für dieses Ergebnis sind höhere Tidalvolumina, die zu längeren Unterbrechungen ohne Herzdruckmassage führten.

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Authors and Affiliations

  1. Department of Medicine III, University Hospital of the Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Germany

    J. Schröder MD

  2. Department of Anesthesiology, University Hospital of the Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Germany

    M. Bucher MD

  3. Institute for Emergency Medicine and Management in Medicine—INM, Klinikum der Universität München, Schillerstr. 53, 80336, Munich, Germany

    O. Meyer MD

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Correspondence to J. Schröder MD.

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J. Schröder, M. Bucher, and O. Meyer state that there are no conflicts of interest.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent was obtained from all patients included in the study.

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Schröder, J., Bucher, M. & Meyer, O. Effect of the laryngeal tube on the no-flow-time in a simulated two rescuer basic life support setting with inexperienced users. Med Klin Intensivmed Notfmed 111, 493–500 (2016). https://doi.org/10.1007/s00063-015-0088-x

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