Randomised crossover comparison of the ~Tulip®

Randomised crossover comparison of the Tulip® airway compared with the Guedel airway for inexperienced users in a manikin (presented AAGBI September 2012).

M. Kynoch, R. Saini, N. Robinson, M. Hasan, D. Vaughan and A. Shaikh.

Chelsea and Westminster, Central Middlesex, Northwick Park, London, UK.

mikekynoch@gmail.com

Introduction

Successful resuscitation requires prompt management of the airway. Basic Life Support (BLS) trained providers, typically with only limited airway skills, are often the first responders. They must manage the patient until the arrival of personnel with advanced airway skills, and frequently look to use an oropharyngeal airway device to assist with airway management. This study aimed to compare two different oropharngeal airways, the Tulip airway (The Age of Aquarius Limited, U.K.) and the Guedel airway, to establish which is easier to use, and more efficient, when used by an inexperienced user (IU), on their own, when ventilating a manikin (TRUCORP AirSim Advance). We collected data on: ease of insertion of each device, the ability to use each device without the need to ask for assistance to produce a satisfactory chest expansion, average tidal volumes (Vt) generated for the first ten successful breaths, and finally the number of attempts taken to insert each device.

Methods

Sixty IU’s, who were defined as being a BLS provider, were recruited and consented on the day of assessment. We recruited from non-Anaesthetic doctors, Recovery room Nurses, Operating Department Assistants, Ward Nurses and Scrub Nurses. Study participants were randomised into one of two groups, using computer generated random numbers in brown sealed envelopes. This established which of the two devices they were to use first. Both airway adjuncts were inserted by the same IU in the same manikin, to cancel out any sequential bias that may occur in the statistical results. Training was given to all participants of the study, in the form of a written Information Sheet, accompanied by a one minute training video. A step-by-step demonstration accompanied by verbal instruction then followed. A resuscitation scenario was prepared, with a manikin simulating a patient in cardiorespiratory arrest. The IU was instructed to start giving airway and ventilatory support using an airway adjunct and BVM.  The supervising anaesthetist intervened if requested, to assist with a two-operator technique for BVM ventilation. A separate anaesthetic observer recorded outcome data.

Results

Twelve IU’s required assistance (20%) to generate satisfactory tidal volumes using a Guedel, significantly more than when using the Tulip (0% assistance requested, p=0.00026). The average Vt generated, when used as a single-operator technique, was significantly greater with the Tulip and BVM (397ml) compared with the same IU’s using the Guedel and BVM (364ml, p=0.0423). There was no significant difference noted between the number of attempts to insert either device first time, 56 out of 60 for the Tulip and 59 for the Guedel. There was a significant difference noted when the IU’s were asked to state which device they found easier to use. Forty six stated that they preferred using the Tulip and only 14 preferred using the Guedel (one-sample z scores of -4.15 to 4.15, p=<0.05).

Discussion

This study concludes that the Tulip oropharyngeal airway is a viable alternative to the Guedel in assisting airway management. We also established it to be significantly easier to use as a single operator, is significantly more efficient, and is the preferred device when used by the inexperienced user.