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Larynxmaske oder Larynxtubus

Welches Hilfsmittel zur extraglottischen Atemwegssicherung ist das richtige für den Rettungsdienst?

Laryngeal mask or laryngeal tube

Which is better for extraglottic airway management by emergency medical services?

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Notfall + Rettungsmedizin Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Extraglottische Atemwege (EGA) sind aufgrund ihrer Anwenderfreundlichkeit in der prähospitalen Notfallversorgung nicht nur Alternativverfahren für den schwierigen Atemweg. Sie können in bestimmten Situationen je nach Ausbildungsstand des Anwenders auch die Erstwahlmittel für die Atemwegssicherung sein. Die Vielzahl an Herstellern und Typen von EGA machen die Identifizierung des optimalen EGA für den eigenen Rettungsdienstbereich schwierig.

Methode

Diese Übersicht vergleicht auf Basis einer Medline-Recherche Larynxmaske (LM) und Larynxtubus (LT) für die prähospitale Notfallmedizin.

Ergebnisse und Schlussfolgerungen

Die Datenlage aus der prähospitalen Notfallmedizin ist für eine qualitative Beurteilung der EGA momentan noch zu schwach. Klinische Studien belegen für die Anwendung von LM und LT eine weitestgehend vergleichbare Qualität. Bei der Anwendung des LT kommt es häufiger als bei der LM zu Komplikationen wie Atemwegsobstruktion und Störungen der Zungenperfusion. Diese Komplikationen scheinen in der prähospitalen Anwendung ausgeprägter und mit z. T. lebensgefährlichen Folgen aufzutreten. Hierzu werden Modifikationen des prähospitalen Standards bei der Anwendung der EGA empfohlen. Die Vorteile der EGA der 2. Generation werden diskutiert. Aktuell scheint eine gute Ausbildung und Routine mit der LM oder dem LT wahrscheinlich deutlich mehr Anwendungssicherheit nach sich zu ziehen als mögliche Qualitätsunterschiede zwischen diesen Atemwegshilfen. Die Entscheidung für den optimalen EGA im eigenen Rettungsdienstbereich sollte dieser Feststellung gerecht werden.

Abstract

Background

In emergency medicine extraglottic airways (EGAs) are—because of their ease of use—not only alternatives in the management of the difficult airway but also first choice for emergency airway management in special circumstances. The variety of manufacturers and types of EGAs makes identification of the optimal EGA for the one's own emergency medical services difficult.

Method

On the basis of a Medline search this overview compares the laryngeal mask (LM) and the laryngeal tube (LT) for emergency medicine.

Results and conclusions

Current literature arising from emergency medicine is insufficient to compare the quality of these EGAs. Clinical studies demonstrate comparable quality of LM and LT for the operator’s purposes. Nevertheless new observations from out-of-hospital use of the LT in emergency situations point out severe complications partially leading to life-threatening sequelae, so that a modified standard for application of the LT is recommended. The advantages of the EGA with gastric access reducing stomach-distension, risk of aspiration and allowing control of the airway’s placement are discussed. Currently the benefit of training and routine use in the application of the LM or LT seems to be superior to the potential differences in quality of these EGAs. Thus, the choice of the optimal EGA for the one's own emergency medical services should take into consideration these circumstances.

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Danksagung

Wir danken Dr. S. Little für die Unterstützung bei diesem Manuskript.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie, Operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Gießen und Marburg GmbH – Standort Gießen, Rudolf-Buchheim-Straße 7, 35382, Gießen, Deutschland

    V. Mann, N. Lenz & M. Henrich

  2. Klinik für Orthopädie und Unfallchirurgie, Zentralklinik Bad Berka, Bad Berka, Deutschland

    S.T. Mann

  3. Abteilung Medizinische Informatik, Carl von Ossietzky Universität, Oldenburg, Deutschland

    R. Röhrig

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Correspondence to V. Mann.

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Mann, V., Mann, S., Lenz, N. et al. Larynxmaske oder Larynxtubus. Notfall Rettungsmed 18, 370–376 (2015). https://doi.org/10.1007/s10049-015-0015-y

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