Literature search for studies with supraglotic devices and manikin studies or comparison studies

Literature search for studies with supraglotic devices and manikin studies or comparison studies

Manikin evaluation of the Tulip – a new supraglottic airway
Anaesthesia, 2009, 64, pages 793–813
S. Harrison,1 N. P. Robinson,2 A. Shaikh3 and S. M. Yentis4

What it’s about:
3 operators inserted 3 devices (LMA, iGel, Tulip) in manikins.
Each device inserted 3 times in total.

Measured data:

  • Ease of insertion and manual ventilation scored 1- 10 (1=impossible, 10=easy) for each
  • Audible leak pressure / max inflation pressures
  • FO view of cords via device 1=no view, 5=great view

Results:
Tulip scored as easiest to insert when compared to iGel #5 or LMA #5

Issues:
Small numbers
Unblinded therefore learning may have occurred.
Subjective

Crossover Comparison of the Laryngeal Mask Supreme™ and the i-gel™ in Simulated Difficult Airway Scenario in Anesthetized Patients
Anesthesiology 2009; 111:55–62
Lorenz G. Theiler, M.D. et al

What it’s about:
Prospective crossover randomised control trial.
Simulated diff airway scenario with hard collar (reduced neck mvt) and limited MO.
60 pts, devices inserted in a random order.

Primary outcome:

  • Overall insertion success rate.
  • Insertion difficulty was graded 1 (easy) to 5 (impossible) by the investigator. Duration of insertion was measured from the time the facemask was taken away from the face until successful ventilation of the patient.
  • Success was defined as two consecutive tidal volumes of at least 6 ml/kg ideal body weight (height in cm – 100) applied by the anesthesia machine.
  • Duration of insertion of the successful attempts was compared.

Other measurements were

  • time to successful ventilation,
  • airway leak pressure – closing APL with 3L flow rates and noting the pressure at which equilibrium reached or audible leak.
  • fiberoptic glottic view – graded from 1–4 as recommended by Cook et al
  • and adverse events-
  • aspiration/regurgitation (gastric fluid in the ventilation tube or in the hypopharynx),
  • desaturation (SaO2 less than 92%),
  • bronchospasm,
  • airway obstruction,
  • coughing,
  • dental, tongue, or lip trauma.

Results:
Success rate for insertion similar both LMA-S and igel (95% vs 93%)
LMA-S needed shorter insertion time
Similar Vt and leak pressures generated for both.

Assessment of the speed and ease of insertion of three supraglottic airway devices by paramedics: a manikin study
EMJ Online First, published on June 1, 2010 as 10.1136/emj.2009.084343
Nick Castle,3 Robert Owen,1 Mark Hann,2 Raveen Naidoo,3 David Reeves2

What it’s about:
36 paramedic students were timed to ascertain how long it took them to place an Igel, laryngeal mask airway (LMA) or laryngeal tube airway (LTA) into a manikin.
Randomised order of insertion.
Following insertion, students were interviewed to see which device they preferred and why.

Measured data:
Time taken to insert – ? end point
Semi-structured qualitative questionnaire of participants at end to determine their device preference.

Results:
iGel was fastest to insert and was the preferred airway of the 3 to use quoting the ease of use and speed of insertion as reasons.

I-gel insertion by novices in manikins and patients*
Anaesthesia, 2008, 63, pages 991–995
N. M viagra est efficace. Wharton,1 B. Gibbison,2 D. A. Gabbott,3 G. M. Haslam,4 N. Muchatuta1 and
T. M. Cook5

What it’s about:

  • 2 limbs – insertion in manikin; insertion in anaesthetised pts.
  • 50 airway novices chosen – medical students, non-anaesthetist physicians and operating department practitioners.
  • Airsim Trucorp manikin chosen – We chose this manikin as previous work had found this to be a well performing surrogate for use with SADs and the i-gel in particular [Jackson K, Cook TM. Evaluation of four airway training manikins as patient simulators for the insertion of eight types of supraglottic airway devices. Anaesthesia 2007; 62: 388–93.]

Measured data:

  • number of attempts,
  • success ⁄ failure ……. As determined by what criteria??
  • ease of insertion …… subjective view
  • time taken for insertion (from picking up the i-gel to successful ventilation of the manikin lungs with a selfinflating bag) … again successful ventilation deemed by what??
  • leak pressures – closing APL and keeping 5l flows and recording plateau or audible leak letting pressures rise to max of 40cm/H2O
  • number and type of airway manipulations required to aid insertion,
  • and complications.

Results:
80ish% success rate with 1st attempt for insertion
Median insertion time 17.5 secs
Median leak pressure 20cm/H2O
Deemed to compare favourably with other supraglotic devices out there.

[There is controversy regarding non-anaesthetists undertaking tracheal intubation [4, 5]. Reported failure rates by non-anaesthetists may exceed 30% [6] and be associated with prolonged insertion times. The European Resuscitation Council (ERC) published a revised edition of resuscitation guidelines for cardiac arrest in November 2005 [7] which included increased emphasis on use of supraglottic airways to establish and maintain the airway when tracheal intubation was not immediately feasible.]

Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin
Schälte et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011, 19:60

What it’s about:

  • Four different supraglottic airway devices: Laryngeal Mask Classic (LMA), Laryngeal Tube (LT), Intubating Laryngeal Mask (FT) and CobraPLA (Cobra) were tested in 141 volunteers recruited in a technical university cafeteria and in a shopping mall.
  • All volunteers received a brief standardized training session.

Primary outcome:

  • Time required for definitive insertion – time until 1st manual ventilation
  • Success
  • Leak Y/N
  • Attempts

Measured data:

  • A tidal volume of > 500 ml was considered as sufficient according to the ERC resuscitation guidelines.
  • A tidal volume of less than < 500 ml was deemed insufficient.
  • An expiratory tidal volume > 800 ml was classed as no leakage, 500-799 ml as minor leakage and < 500 ml as major leakage.

Results:
Longest time to insert was with the Cobra – the other 3 all similar
Fewest insertion attempts with FT then LMA, LT, Cobra (last)
Ventilation achieved on 1st go most often with the FT
90% participants felt a supraglotic device should be in first aid algorithms and classes.

Which is more effective for ventilation in the prehospital setting during cardiopulmonary resuscitation, the laryngeal mask airway or the bag-valve-mask? – A review of the literature
Journal of Emergency Primary Health Care (JEPHC), Vol. 8, Issue 3, 2010 – Article 990410
Gereon Schälte1*, Christian Stoppe1, Meral Aktas2, Mark Coburn1, Steffen Rex1, Marlon Schwarz1, Rolf Rossaint1 and Norbert Zoremba1

What it’s about:

A literature search was conducted using medical electronic databases, MEDLINE CINHAL, EMBASE, Meditext, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus.

These databases were searched from January 1996 until the end of January 2010.

Articles were included if the principal objective was to compare ventilation efficiency of the LMA against the BVM in the prehospital setting. References from articles retrieved were reviewed.

Measured data:

There were 2937 articles located by the search.

Of these, 30 articles met the inclusion criteria with twelve relevant to the prehospital environment.
In the twelve prehospital studies, two involved the use of mannequins, four were retrospective, five were observational, and there was one a literature review.

Conclusions:

The findings from this review suggest that the LMA is more effective at ventilations over time during CPR in adults, as there is less risk of gastric regurgitation and pulmonary aspiration.
The BVM is quicker at performing the first ventilation but there is a loss of effectiveness over time.
BVM is considered the best method for ventilating children and neonates.


International and World Wide Patents Granted | ~ Age of Aquarius | info@tulipairway.co.uk

International and World Wide Patents Granted -
Dr Amer Shaikh