Prehospital/EMS Articles of the Year Selected by Prehospitalmed.com
PHARM: Prehospital and Retrieval Medicine (www.prehospitalmed.com) a blog produced by Dr. Minh Le Cong of Australia, has posted its 2014 Prehospital/EMS Articles of the Year, which includes the following four articles relating to airway management. Visit http://prehospitalmed.com/2015/03/03/2014-prehospitalems-articles-of-the-year/ for the complete listing of all categories.
Wimalasena Y, Burns B, Reid C, Ware S, Habig K, Med M. Apneic Oxygenation Was Associated With Decreased Desaturation Rates During Rapid Sequence Intubation by an Australian Helicopter Emergency Medicine Service. Ann. Emerg. Med. 2014:1-7. doi:10.1016/j.annemergmed.2014.11.014. PubMed (http://www.ncbi.nlm.nih.gov/pubmed/25536868)
Reviewer: Rob Bryant MD. Utah Emergency Physicians, Salt Lake City, UT
● Why is this important? This is a retrospective review of prospectively collected airway registry data evaluating the impact of Nasal Cannula apneic oxygenation on the incidence of peri-intubation hypoxemia (Sat<93% at any time during induction of anesthesia and intubation, regardless of any pre-existing hypoxemia). In 728 Intubations, (310 pre, 418 post introduction of apneic oxygenation) the incidence of peri-intubation hypoxemia dropped from 22.6 to 16.5% with the use of apneic oxygenation.
● Limitations: Retrospective study of registry data. Study suggests an association between apneic oxygenation and decreased hypoxemia. A higher cutoff for hypoxemia was used than in other HEMS studies, giving a higher pre and post intervention incidence of hypoxemia.
Burnett AM, Frascone RJ, Wewerka SS, et al. Comparison of success rates between two video laryngoscope systems used in a prehospital clinical trial. Prehosp. Emerg. Care 18:231-8. doi:10.3109/10903127.2013.851309. [PubMed] (http://www.ncbi.nlm.nih.gov/pubmed/24400965)
Reviewer: Mike Steuerwald, M.D., University of Cincinnati
● Why is this important? The primary aim of this study was to compare paramedic intubation success rates between two different video laryngoscope systems. This particular trial is notable as the authors chose to compare an indirect, hyper-curved video system (KV) to a standard geometry video system capable of both direct and indirect visualization strategies (C-MAC with Mac 4 blade loaded).
● Limitations: Several limitations exist. Most notably, no information was given about the training provided. I would like to know exactly how the providers were trained to use the standard geometry blades. The authors conclude that this device functioned poorer than historical DL, which is interesting considering the C-Mac Mac 4 is a very capable direct laryngoscope.
Mabry RL, Nichols MC, Shiner DC, Bolleter S, Frankfurt A. A comparison of two open surgical cricothyroidotomy techniques by military medics using a cadaver model. Ann. Emerg. Med. 2014;63(1):1-5. doi:10.1016/j.annemergmed.2013.08.025. [PubMed] (http://www.ncbi.nlm.nih.gov/pubmed/24094476)
Reviewer: Mike Steuerwald, M.D., University of Cincinnati
● Why is this important? The primary aim of this study was to compare standard open surgical cricothyroidotomy with cricothyroidotomy facilitated by the CricKey device. The CricKey was faster to insert and demonstrated a trend towards increased first attempt success.
● Limitations: This was a cadaver-based trial without any bleeding in the model (simulated or otherwise). The study also remarked that the cadavers had easily discernible neck anatomy.
McMullan J, Gerecht R, Bonomo J, et al. Airway management and out-of-hospital cardiac arrest outcome in the CARES registry. Resuscitation 2014;85(5):617-622. doi:10.1016/j.resuscitation.2014.02.007. [PubMed] (http://www.ncbi.nlm.nih.gov/pubmed/24561079)
Reviewer: Justin Benoit, MD, University of Cincinnati
● Why is this important? Our current understanding of airway management during out of hospital cardiac arrest is bag-valve mask > endotracheal intubation > supraglottic airways. This US based study mirrors data from Japan (Hasegawa 2013).
● Limitations: Observational study. Results could be confounded by indication – i.e. less sick patients got only BVM.
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