Academic Journal
Impact of COVID-19-adapted guidelines using different airway management strategies on resuscitation quality in out-of-hospital-cardiac-arrest – a randomised manikin study
| Title: | Impact of COVID-19-adapted guidelines using different airway management strategies on resuscitation quality in out-of-hospital-cardiac-arrest – a randomised manikin study |
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| Authors: | Sean S. Scholz, Sissy Linder, Eugen Latka, Tobias Bartnick, Daniel Karla, Daniel Thaemel, Marlena Wolff, Odile Sauzet, Sebastian W. Rehberg, Karl-Christian Thies, Gerrit Jansen |
| Source: | BMC Emergency Medicine, Vol 23, Iss 1, Pp 1-11 (2023) |
| Publisher Information: | BMC, 2023. |
| Publication Year: | 2023 |
| Collection: | LCC:Special situations and conditions LCC:Medical emergencies. Critical care. Intensive care. First aid |
| Subject Terms: | Aerosol liberation, CPR, Extraglottic airway, Supraglottic airway, Chest compression, Special situations and conditions, RC952-1245, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9 |
| More Details: | Abstract Background Although airway management for paramedics has moved away from endotracheal intubation towards extraglottic airway devices in recent years, in the context of COVID-19, endotracheal intubation has seen a revival. Endotracheal intubation has been recommended again under the assumption that it provides better protection against aerosol liberation and infection risk for care providers than extraglottic airway devices accepting an increase in no-flow time and possibly worsen patient outcomes. Methods In this manikin study paramedics performed advanced cardiac life support with non-shockable (Non-VF) and shockable rhythms (VF) in four settings: ERC guidelines 2021 (control), COVID-19-guidelines using videolaryngoscopic intubation (COVID-19-intubation), laryngeal mask (COVID-19-Laryngeal-Mask) or a modified laryngeal mask modified with a shower cap (COVID-19-showercap) to reduce aerosol liberation simulated by a fog machine. Primary endpoint was no-flow-time, secondary endpoints included data on airway management as well as the participants‘ subjective assessment of aerosol release using a Likert-scale (0 = no release–10 = maximum release) were collected and statistically compared. Continuous Data was presented as mean ± standard deviation. Interval-scaled Data were presented as median and Q1 and Q3. Results A total of 120 resuscitation scenarios were completed. Compared to control (Non-VF:11 ± 3 s, VF:12 ± 3 s) application of COVID-19-adapted guidelines lead to prolonged no-flow times in all groups (COVID-19-Intubation: Non-VF:17 ± 11 s, VF:19 ± 5 s;p ≤ 0.001; COVID-19-laryngeal-mask: VF:15 ± 5 s,p ≤ 0.01; COVID-19-showercap: VF:15 ± 3 s,p ≤ 0.01). Compared to COVID-19-Intubation, the use of the laryngeal mask and its modification with a showercap both led to a reduction of no-flow-time(COVID-19-laryngeal-mask: Non-VF:p = 0.002;VF:p ≤ 0.001; COVID-19-Showercap: Non-VF:p ≤ 0.001;VF:p = 0.002) due to a reduced duration of intubation (COVID-19-Intubation: Non-VF:40 ± 19 s;VF:33 ± 17 s; both p ≤ 0.01 vs. control, COVID-19-Laryngeal-Mask (Non-VF:15 ± 7 s;VF:13 ± 5 s;p > 0.05) and COVID-19-Shower-cap (Non-VF:15 ± 5 s;VF:17 ± 5 s;p > 0.05). The participants rated aerosol liberation lowest in COVID-19-intubation (median:0;Q1:0,Q3:2;p |
| Document Type: | article |
| File Description: | electronic resource |
| Language: | English |
| ISSN: | 1471-227X |
| Relation: | https://doaj.org/toc/1471-227X |
| DOI: | 10.1186/s12873-023-00820-y |
| Access URL: | https://doaj.org/article/3b5bdd22de44463cb5a732e6120dc6a8 |
| Accession Number: | edsdoj.3b5bdd22de44463cb5a732e6120dc6a8 |
| Database: | Directory of Open Access Journals |
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| ISSN: | 1471227X |
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| DOI: | 10.1186/s12873-023-00820-y |
| Published in: | BMC Emergency Medicine |
| Language: | English |