Emergency Department Management of Out-of-Hospital Laryngeal Tubes - 23/08/19
, Sarah K. Scharber, BS b, Gabriella B. Horton a, Darren A. Braude, MD, EMT-P c, Nicholas S. Simpson, MD a, Robert F. Reardon, MD aAbstract |
Study objective |
Laryngeal tubes are commonly used by emergency medical services (EMS) personnel for out-of-hospital advanced airway management. The emergency department (ED) management of EMS-placed laryngeal tubes is unknown. We seek to describe ED airway management techniques, success, and complications of patients receiving EMS laryngeal tubes.
Methods |
Using a keyword text search of ED notes, we identified patients who arrived at our ED with a laryngeal tube from 2010 through 2017. We performed structured chart and video reviews for all eligible patients. In our ED, emergency physicians perform all airway management, and there is no protocol dictating airway management for patients arriving with a laryngeal tube. Using descriptive methods, we report the techniques, success, and complications of ED airway management.
Results |
We analyzed data on 647 patients receiving out-of-hospital laryngeal tubes, including 472 (73%) with cardiac arrest from medical causes, 75 (21%) with cardiac arrest from trauma, and 100 (15%) with other conditions. For 580 patients (89%), emergency physicians exchanged the laryngeal tube for a definitive airway in the ED. Of the 67 patients not intubated in the ED, 66 died in the ED without further airway management. Of the 580 patients intubated in the ED, orotracheal intubation was the first method attempted for 578 (>99%) and was successful on the first attempt for 515 of 578 (89%). Macintosh video laryngoscopy (88% of initial attempts) and a bougie (68% of initial attempts) were commonly used adjuncts. For 345 of 578 patients (60%), the laryngeal tube was removed before intubation attempts. For 112 of 578 patients (19%), the first intubation attempt occurred with the deflated laryngeal tube left in place. Three patients (<1%) required a surgical airway.
Conclusion |
In this cohort, emergency physicians successfully exchanged an out-of-hospital laryngeal tube for an endotracheal tube, using commonly available airway management techniques. ED clinicians should be familiar with techniques for exchanging out-of-hospital extraglottic airways for an endotracheal tube.
Le texte complet de cet article est disponible en PDF.Plan
| Please see page 404 for the Editor’s Capsule Summary of this article. |
|
| Supervising editor: Henry E. Wang, MD, MS. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
|
| Author contributions: BED, SKS, DAB, and RFR conceived and designed the study. BED trained and supervised the data abstractors. SKS and GBH performed chart and video review. BED and SKS performed the data analysis. DAB and NSS used out-of-hospital expertise to interpret the data. BED drafted the initial article, and all authors contributed substantially to its revision. BED takes responsibility for the paper as a whole. |
|
| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
|
| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. |
|
| Readers: click on the link to go directly to a survey in which you can provide P9W3NZP to Annals on this particular article. |
|
| A podcast for this article is available at www.annemergmed.com. |
Vol 74 - N° 3
P. 403-409 - septembre 2019 Retour au numéro
Article précédent
- What Is the Diagnostic Accuracy of Point-of-Care Ultrasonography in Patients With Suspected Blunt Thoracoabdominal Trauma?
- Brit Long, Michael D. April
- Use of End Tidal Oxygen Monitoring to Assess Preoxygenation During Rapid Sequence Intubation in the Emergency Department
- Nicholas D. Caputo, Matthew Oliver, Jason R. West, Robert Hackett, John C. Sakles
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?