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Evaluation of chest compression effect on airway management with air-Q®, aura-i®, i-gel®, and Fastrack® intubating supraglottic devices by novice physicians: a randomized crossover simulation study

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Abstract

Purpose

In the 2010 American Heart Association guidelines, supraglottic devices (SGDs) such as the laryngeal mask are proposed as alternatives to tracheal intubation for cardiopulmonary resuscitation. Some SGDs can also serve as a means for tracheal intubation after successful ventilation. The purpose of this study was to evaluate the effect of chest compression on airway management with four intubating SGDs, aura-i® (aura-i), air-Q® (air-Q), i-gel® (i-gel), and Fastrack® (Fastrack), during cardiopulmonary resuscitation using a manikin.

Methods

Twenty novice physicians inserted the four intubating SGDs into a manikin with or without chest compression. Insertion time and successful ventilation rate were measured. For cases of successful ventilation, blind tracheal intubation via the intubating SGD was performed with chest compression and success or failure within 30 s was recorded.

Results

Chest compression did not decrease the ventilation success rate of the four intubating SGDs (without chest compression (success/total): air-Q, 19/20; aura-i, 19/20; i-gel, 18/20; Fastrack, 19/20; with chest compression: air-Q, 19/20; aura-i, 19/20; i-gel, 16/20; Fastrack, 18/20). Insertion time was significantly lengthened by chest compression in the i-gel trial (P < 0.05), but not with the other three devices. The blind intubation success rate with chest compression was the highest in the air-Q trial (air-Q, 15/19; aura-i, 14/19; i-gel, 12/16; Fastrack, 10/18).

Conclusions

This simulation study revealed the utility of intubating SGDs for airway management during chest compression.

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References

  1. Hazinski MF, Nolan JP, Billi JE, Böttiger BW, Bossaert L, de Caen AR, Deakin CD, Drajer S, Eigel B, Hickey RW, Jacobs I, Kleinman ME, Kloeck W, Koster RW, Lim SH, Mancini ME, Montgomery WH, Morley PT, Morrison LJ, Nadkarni VM, O’Connor RE, Okada K, Perlman JM, Sayre MR, Shuster M, Soar J, Sunde K, Travers AH, Wyllie J, Zideman D. Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010;122:S250–75.

    Article  PubMed  Google Scholar 

  2. Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, Kudenchuk PJ, Ornato JP, McNally B, Silvers SM, Passman RS, White RD, Hess EP, Tang W, Davis D, Sinz E, Morrison LJ. Part 8: Adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S729–67.

    Article  PubMed  Google Scholar 

  3. Asai T, Murao K, Shingu K. Efficacy of the ProSeal laryngeal mask airway during manual in-line stabilisation of the neck. Anaesthesia. 2001;57:918–20.

    Article  Google Scholar 

  4. Reinhart DJ, Simmons G. Comparison of placement of the laryngeal mask airway with endotracheal tube by paramedics and respiratory therapists. Ann Emerg Med. 1994;24:260–3.

    Article  PubMed  CAS  Google Scholar 

  5. Häske D, Schempf B, Gaier G, Niederberger C. Performance of the i-gel™ during pre-hospital cardiopulmonary resuscitation. Resuscitation. 2013;84:1229–32.

    Article  PubMed  Google Scholar 

  6. Asai T. Intubating laryngeal mask airway after failed insertion of a classic laryngeal mask. Anaesthesia. 2006;61:303.

    Article  PubMed  CAS  Google Scholar 

  7. Komasawa N, Ueki R, Yamamoto N, Atagi K, Nishi S, Kaminoh Y, Tashiro C. Comparison of air-Q® and Soft Seal® laryngeal mask for airway management by novice doctors during infant chest compression: a manikin study. Resuscitation. 2012;83:365–8.

    Article  PubMed  Google Scholar 

  8. Reinhart DJ, Simmons G. Comparison of placement of the laryngeal mask airway with endotracheal tube by paramedics and respiratory therapists. Ann Emerg Med. 1994;24:260–3.

    Article  PubMed  CAS  Google Scholar 

  9. Komasawa N, Ueki R, Nomura H, Itani M, Kaminoh Y. Comparison of tracheal intubation by Macintosh laryngoscope and Pentax-AWS (Airway Scope) during chest compression: a manikin study. J Anesth. 2010;24:306–8.

    Article  PubMed  Google Scholar 

  10. Combes X, Le Roux B, Suen P, Dumerat M, Motamed C, Sauvat S, Duvaldestin P, Dhonneur G. Unanticipated difficult airway in anesthetized patients: prospective validation of a management algorithm. Anesthesiology. 2004;100:1146–50.

    Article  PubMed  Google Scholar 

  11. Kohama H, Komasawa N, Ueki R, Samma A, Nakagawa M, Nishi S, Kaminoh Y. Comparison of Supreme® and Soft Seal® laryngeal masks for airway management during cardiopulmonary resuscitation in novice doctors: a manikin study. J Anesth. 2011;25:98–103.

    Article  PubMed  Google Scholar 

  12. Vaida SJ, Yodfat UA. Angulation of the airway tube in the AMBU laryngeal mask could be responsible for improved insertion success. Anesth Analg. 2006;103:264.

    Article  PubMed  Google Scholar 

  13. Theiler LG, Kleine-Brueggeney M, Kaiser D, Urwyler N, Luyet C, Vogt A, Greif R, Unibe MM. Crossover comparison of the laryngeal mask supreme and the i-gel in simulated difficult airway scenario in anesthetized patients. Anesthesiology. 2009;111:55–62.

    Article  PubMed  Google Scholar 

  14. Asai T, Eguchi Y, Murao K, Niitsu T, Shingu K. Intubating laryngeal mask for fibreoptic intubation—particularly useful during neck stabilization. Can J Anaesth. 2000;47:843–8.

    Article  PubMed  CAS  Google Scholar 

  15. Frappier J, Guenoun T, Journois D, Philippe H, Aka E, Cadi P, Silleran-Chassany J, Safran D. Airway management using the intubating laryngeal mask airway for the morbidly obese patient. Anesth Analg. 2003;96:1510–5.

    Article  PubMed  Google Scholar 

  16. Timmermann A. Supraglottic airways in difficult airway management: successes, failures, use and misuse. Anaesthesia. 2011;66(suppl 2):45–56.

    Article  PubMed  Google Scholar 

  17. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A; American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013;118:251–270.

    Google Scholar 

  18. Wang HE, Simeone SJ, Weaver MD, Callaway CW. Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation. Ann Emerg Med. 2009;54:645–52.

    Article  PubMed  Google Scholar 

  19. Fukutome T, Amaha K, Nakazawa K, Kawamura T, Noguchi H. Tracheal intubation through the intubating laryngeal mask airway (LMA-Fastrach) in patients with difficult airways. Anaesth Intensive Care. 1998;26:387–91.

    PubMed  CAS  Google Scholar 

  20. Galgon RE, Schroeder KM, Schmidt CS, Matioc AA, Han S, Andrei AC, Joffe AM. Fiberoptic-guided tracheal tube placement through the air-Q® Intubating Laryngeal Airway: a performance study in a manikin. J Anesth. 2011;25:721–6.

    Article  PubMed  Google Scholar 

  21. Alexander R, Hodgson P, Lomax D, Bullen C. A comparison of the laryngeal mask airway and Guedel airway, bag and face mask for manual ventilation following formal training. Anaesthesia. 1993;48:231–4.

    Article  PubMed  CAS  Google Scholar 

  22. Komasawa N, Ueki R, Itani M, Nishi S, Kaminoh Y. Validation of the Pentax-AWS Airway Scope utility as an intubation device during cardiopulmonary resuscitation on the ground. J Anesth. 2010;24:582–6.

    Article  PubMed  Google Scholar 

  23. Jordan GM, Silsby J, Bayley G, Cook TM, Difficult Airway Society. Evaluation of four manikins as simulators for teaching airway management procedures specified in the Difficult Airway Society guidelines, and other advanced airway skills. Anaesthesia. 2007;62:708–12.

    Article  PubMed  CAS  Google Scholar 

  24. Gatward JJ, Thomas JC, Nolan JP, Cook TM. Effect of chest compressions on the time taken to insert airway devices in a manikin. Br J Anaesth. 2008;100:351–6.

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

The authors have no affiliation with any manufacturer of any device described in the manuscript and declare no financial interest in relationship to the material described here. Financial support for the study was provided by our institution and department.

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Authors and Affiliations

  1. Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka, 569-8686, Japan

    Nobuyasu Komasawa

  2. Department of Anesthesiology, Hyogo College of Medicine, Nishinomiya, Japan

    Ryusuke Ueki

  3. Division of Anesthesiology, Social Insurance Kinan Hospital, Tanabe, Japan

    Yoshiroh Kaminoh

  4. Division of Intensive Care Unit, Hyogo College of Medicine, Nishinomiya, Japan

    Shin-ichi Nishi

Authors
  1. Nobuyasu Komasawa
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  2. Ryusuke Ueki
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  3. Yoshiroh Kaminoh
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  4. Shin-ichi Nishi
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Corresponding author

Correspondence to Nobuyasu Komasawa.

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Komasawa, N., Ueki, R., Kaminoh, Y. et al. Evaluation of chest compression effect on airway management with air-Q®, aura-i®, i-gel®, and Fastrack® intubating supraglottic devices by novice physicians: a randomized crossover simulation study. J Anesth 28, 676–680 (2014). https://doi.org/10.1007/s00540-014-1802-1

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  • DOI: https://doi.org/10.1007/s00540-014-1802-1

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