Notfallintubationsausbildung von Ungeübten: Kann die Videolaryngoskopie den Lernerfolg verbessern?

Gegenstand: Die endotracheale Intubation ist trotz der Verfügbarkeit supraglottischer Atemwegshilfen (SGA) unverändert Goldstandard der Atemwegsicherung in der Notfallmedizin und möglicherweise bei der Reanimation den SGA überlegen (1). Allerdings erfordert die konventionelle...

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Bibliographic Details
Main Author: Coxhead, Tillmann
Contributors: Kill, Clemens (Prof. Dr.) (Thesis advisor)
Format: Dissertation
Published: Philipps-Universität Marburg 2017
Klinik für Anästhesie und Intensivtherapie
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Table of Contents: Objective: Endotracheal intubation (ET) remains the gold standard for securing the airway despite the advent of supraglottic airway devices (SGA). The main contraindication to the use of SGA is the increased risk of regurgitation(1). However, conventional ET requires extensive experience to yield high success rates (2, 3). Videolaryngoscopy often improves the preconditions for ET. The objective of this study was to investigate whether the use of GlideScope® videolaryngoscopy by persons with no prior airway management experience could increase the success rate of ET and reduce the incidence of secondary injury to the patient. Method: Following approval by the ethic commission, 36 paramedic trainees without any previous airway management experience were recruited. Trainees with previous experience were excluded. The test persons were randomly assigned to two groups: either the ―Mac‖ group (using Macintosh intubation blades) or the ―GS‖ group (using GlideScope® videolaryngoscopes). Each group consisted of 18 persons who were instructed by means of a teaching video. Each test person was then allowed ten intubation attempts applying the assigned method to an airway trainer (AMT, Fa. Laerdal). The primary end-point was defined as the final position of the endotracheal tube after the test person had put down the laryngoscope. A successful intubation was defined as correct insertion of the endotracheal tube into the trachea within 90 seconds.The primary end point was statistically analyzed by binary logistic regression. Results: There was no significant age or gender difference among the test persons (p=0.68 and p=0.61). The endotracheal tube was introduced correctly into the trachea in 153 (85%) out of 180 attempts in the „MAC ― group and in 174 (97%) out of 180 attempts in the ―GS‖ group. Intubation attempts 1-3: In the „MAC― group 38 (70%) out of 54 attempts were successful, in the „GS― group 50 (93%) out of 54. Intubation attempts 4-7: In the „MAC― group 64 (89%) out of 72 attempts were successful, in the „GS― group 72 (100%) out of 72. Intubation attempts 8-10: In the „MAC― group 51 (94%) out of 54 attempts were successful, in the „GS― group 52 (96%) out of 54. Overall, the actually chosen method of intubation proved to be a significant factor influencing the success rate of ET (p=0.002). Furthermore, misplacement of the endotracheal tube into the oesophagus went significantly less frequently in the ―GS‖ group compared with the ―Mac‖ group (p<0.001). Conclusion: Persons inexperienced with airway management can achieve significantly higher intubation success rates on airway trainers by using a GlideScope® videolaryngoscope compared with a conventional Macintosh laryngoscope. Hence, the routine use of GlideScope® videolaryngoscopy in an emergency setting could prove advantageous for health care professionals especially when inexperienced. References: (1) Wang HE et al: Resuscitation 2012,83(9):1061-6. (2) Bernhard M et al.: Acta Anaesthesiol Scand 2012;56(2):164-71. (3) Timmermann A et al.: Anesth. Analg. 2007,104(3):619-23