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

Auswirkung des Einsatzes des Larynxtubus auf die No-Flow-Zeit in einem simulierten Ein-Helfer-Setting mit Basis-Reanimationsmaßnahmen durch unerfahrenes Personal

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Abstract

Background

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

Methods

We performed a manikin study to investigate the effect of using the LT for ventilation instead of BMV on the NFT during BLS in a prospective, randomized, single-rescuer study. All 209 participants were trained in BMV, but were inexperienced in using LT; each participant performed BLS during a 4-min time period.

Results

No significant difference in total NFT (LT: mean 81.1 ± 22.7 s; BMV: mean 83.2 ± 13.1 s, p = 0.414) was found; however, significant differences in the later periods of the scenario were identified. While ventilating with the LT, the proportion of chest compressions increased significantly from 67.2 to 73.2%, whereas the proportion of chest compressions increased only marginally when performing BMV. The quality of the chest compressions and the associated ventilation rate did not differ significantly. The mean tidal volume and mean minute volume were significantly lower when performing BMV.

Conclusions

The NFT was significantly shorter in the later periods in a single-rescuer, cardiac arrest scenario when using an LT without previous training compared with BMV with previous training. A possible explanation for this result may be the complexity and workload of alternating tasks (e.g., time loss when reclining the head and positioning the mask for each ventilation during BMV).

Zusammenfassung

Hintergrund

Der Larynxtubus (LT) ist eine empfohlene Alternative zur endotrachealen Intubation im Rahmen von erweiterten Reanimationsmaßnahmen (Advanced Life Support, ALS). Seine Insertion wird als einfach beschrieben, daher ist er auch eine vorstellbare Alternative zur Beutel-Masken-Beatmung (Beutel-Masken-Ventilation, BMV) für ungeübtes Personal im Rahmen von Basis-Reanimationsmaßnahmen (Basic Life Support, BLS). Studienergebnisse unterstützen einen positiven Einfluss des LT auf die No-Flow-Time (NFT) beim ALS in Manikin-Studien.

Material und Methoden

Wir führten eine prospektive, randomisierte Manikin-Studie durch, um den Einfluss des LT auf die NFT und die Qualität der Beatmung beim BLS im Vergleich zur BMV im Ein-Helfer-Modell zu untersuchen. Alle 209 Probanden waren in BMV ausgebildet, jedoch unerfahren in der Anwendung eines LT.

Ergebnisse

Es zeigte sich kein signifikanter Unterschied in der absoluten NFT (LT: durchschnittlich 81,1 ± 22,7 s; BMV: durchschnittlich 83,2 ± 13,1 s, p = 0,414); jedoch zeigten sich bei Betrachtung der späteren Zeitabschnitte des Reanimationsverlaufs signifikante Unterschiede. Bei Einsatz des LT stieg der zeitliche Anteil an Herzdruckmassage von 67,2 auf 73,2 % signifikant an, während sich bei Einsatz der BMV nur geringe Unterschiede zeigten. Die Qualität der Herzdruckmassage und die Beatmungsfrequenz unterschieden sich nicht signifikant. Die durchschnittlichen Tidal- sowie Atemminutenvolumina waren kleiner bei BMV.

Schlussfolgerungen

Die Anwendung des LT durch ungeübtes Personal im Rahmen des BLS im Ein-Helfer-Modell führt im Vergleich zur BMV durch geübtes Personal im Verlauf der Reanimation zu einer signifikanten Verkürzung der NFT. Eine mögliche Erklärung für dieses Ergebnis ist die Schwierigkeit der Maskenbeatmung und der damit verbundene, höhere Zeitaufwand (z. B. Zeitverlust durch Reklination des Kopfes und der Neupositionierung der Maske in jeder Beatmungspause) bei der BMV, die zu längeren Unterbrechungen ohne Herzdruckmassage führten.

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Acknowledgement

The manuscript was edited by an English language editing service to improve the linguistic quality.

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Authors and Affiliations

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

    O. Meyer

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

    M. Bucher

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

    J. Schröder

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Correspondence to J. Schröder.

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Conflict of interest

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

The accompanying manuscript does not include studies on humans or animals.

Additional information

Authors’ contributions. OM designed the study, MB and JS helped to design and perform the study, and collected the data. OM and JS performed the statistical analysis. All authors participated in the writing process. All authors read and approved the final manuscript.

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Meyer, O., Bucher, M. & Schröder, J. Effect of using a laryngeal tube on the no-flow time in a simulated, single-rescuer, basic life support setting with inexperienced users. Anaesthesist 65, 183–189 (2016). https://doi.org/10.1007/s00101-016-0140-0

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