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Alternative Hilfsmittel zum Atemwegsmanagement in der Notfallmedizin: Pro und Kontra

Alternative airway management devices in emergency medicine: pros and cons

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Zusammenfassung

Die supraglottischen Atemwegshilfen (Larynxmaske, Larynxtubus) haben nach wie vor einen klaren Stellenwert im Algorithmus des erwartet und unerwartet schwierigen Atemwegs. Die Datenlage zum prähospitalen bzw. außerklinischen Atemwegsmanagement ist heterogen und teilweise widersprüchlich. Der vorliegende Beitrag diskutiert die Anwendung des Larynxtubus in der präklinischen Notfallmedizin kritisch und zeigt zum einen klare Vorteile, aber auch Nachteile bei seiner Verwendung auf. Die Pro-Gruppe vertritt die Meinung, dass in der Hand des erfahrenen Anwenders der Larynxtubus aktuell und weiterhin eine wertvolle Alternative zur endotrachealen Intubation beim prähospitalen Management des schwierigen Atemwegs ist, auf die derzeit nicht verzichtet werden sollte. Die Kontra-Gruppe weist auf mehrere Studien hin, die eine hohe Komplikationsrate bei Verwendung des Larynxtubus zeigen. Angesichts dessen sei der Einsatz des Larynxtubus bei der Reanimation außerhalb einer strengen Indikationsstellung derzeit kritisch zu werten.

Abstract

Supraglottic airway devices (laryngeal mask, laryngeal tube) are still used in the algorithm of the expected and unexpected difficult airway. Data on prehospital and outpatient airway management are heterogeneous and sometimes contradictory. This paper critically discusses the use of the laryngeal tube in preclinical emergency medicine and shows clear advantages and disadvantages of its use. Pro: it is argued that the laryngeal tube is a valuable alternative to endotracheal intubation in prehospital management of the difficult respiratory tract in the hands of the experienced user and it should not be abandoned at present. Contra: there is evidence from several studies showing a high complication rate when using the laryngeal tube. With this in mind, the use of the laryngeal tube in resuscitation outside a strict indication should currently be viewed critically.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und Intensivtherapie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, Liebigstr. 20, Haus 4, 04103, Leipzig, Deutschland

    F. Girrbach &  S. Bercker

  2. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland

    J. Hinkelbein

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  1. F. Girrbach
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Correspondence to S. Bercker or J. Hinkelbein.

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Interessenkonflikt

F. Girrbach, S. Bercker und J. Hinkelbein geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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M. Bernhard, Düsseldorf

H. Dormann, Fürth

C. Waydhas, Bochum

Herr F. Girrbach und Herr S. Bercker haben den Kontra-Teil zum Beitrag verfasst. Herr J. Hinkelbein hat den Pro-Teil erstellt.

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Girrbach, F., Bercker, S. & Hinkelbein, J. Alternative Hilfsmittel zum Atemwegsmanagement in der Notfallmedizin: Pro und Kontra. Notfall Rettungsmed 22, 679–684 (2019). https://doi.org/10.1007/s10049-019-00658-7

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