Effect of Early Supraglottic Airway Device Insertion on Chest Compression Fraction during Simulated Out-of-Hospital Cardiac Arrest: Randomised Controlled Trial

Abstract

Early insertion of a supraglottic airway (SGA) device could improve chest compression fraction by allowing providers to perform continuous chest compressions or by shortening the interruptions needed to deliver ventilations. SGA devices do not require the same expertise as endotracheal intubation. This study aimed to determine whether the immediate insertion of an i-gel® while providing continuous chest compressions with asynchronous ventilations could generate higher CCFs than the standard 30:2 approach using a face-mask in a simulation of out-of-hospital cardiac arrest. A multicentre, parallel, randomised, superiority, simulation study was carried out. The primary outcome was the difference in CCF during the first two minutes of resuscitation. Overall and per-cycle CCF quality of compressions and ventilations parameters were also compared. Among thirteen teams of two participants, the early insertion of an i-gel® resulted in higher CCFs during the first two minutes (89.0% vs. 83.6%, p = 0.001). Overall and per-cycle CCF were consistently higher in the i-gel® group, even after the 30:2 alternation had been resumed. In the i-gel® group, ventilation parameters were enhanced, but compressions were significantly shallower (4.6 cm vs. 5.2 cm, p = 0.007). This latter issue must be addressed before clinical trials can be considered.

Efficiency of two-member crews in delivering prehospital advanced life support cardiopulmonary resuscitation: A scoping review

“… 34 , 35 , 36 Its use may have a positive impact on achieving ROSC, though its effect on other clinical outcomes in OHCA remains uncertain. 37 The ease of inserting a laryngeal mask allows for ergonomic approaches like over-the-head CPR and ventilation. 38 …”

The Importance of Acknowledging an Intermediate Category of Airway Management Devices in the Prehospital Setting

“…Further supporting the separate categorization of SGA devices to explore cardiac arrest related outcomes, a recent simulation study unexpectedly discovered that chest compressions were significantly shallower when ventilation was performed when SGA devices were in place than when bag-valve mask devices were used [8]. Should such results be confirmed in actual human studies, this could have significant consequences on cardiac arrest management procedures and could also contribute to explaining the unfavorable outcomes associated with the use of SGA devices.…”

“…There are fundamental differences between SGA and ETI devices. While mastering ETI requires considerable clinical expertise [7], even more so in the austere and hostile prehospital environment, SGA device insertion can be rapidly taught to paramedics and to emergency medical technicians [8]. Moreover, paramedics are still able to successfully insert SGA devices 3 months after their initial training, while their ETI performance drops significantly [9].…”

“…In addition, other researchers might consider that almost all emergency prehospital providers should have been taught and allowed to use SGA devices by now. While we are convinced that enabling the vast majority of prehospital providers to use SGA devices is an important objective since these devices readily improve oxygenation and ventilation in many situations, certified paramedics are still not allowed to use such devices in certain regions of the world [8].…”

Impact of Face-to-Face Teaching in Addition to Electronic Learning on Personal Protective Equipment Doffing Proficiency in Student Paramedics: Randomized Controlled Trial

“…Our hypothesis was that using a blended learning strategy by adding a workshop using Peyton’s approach to an interactive, gamified e-learning module would increase knowledge and skill acquisition and retention regarding PPE doffing procedures in student paramedics. Adhering to Peyton’s approach was thought to be of particular interest since this method is also used during continuous training sessions followed by paramedics in Switzerland [ 29 , 30 ].…”