Neubewertung extraglottischer Atemwegshilfsmittel in der Notfallmedizin

Dieser Artikel gibt einen Überblick über die klinischen Grundlagen von extraglottischen Atemwegshilfen (EGA), beschreibt den potenziell sinnvollen Einsatz in der präklinischen Notfallmedizin, stellt die derzeit aktuellen Studien vor, analysiert mögliche Schwachstellen hinsichtlich der Art der verwendeten Atemwegshilfen und beleuchtet die Ausbildung der medizinischen Notfallteams. Auch der rettungsdienstliche Einsatz von Atemwegshilfen bei Kindern wird dargestellt.

Schlüsselwörter

Atemwege - Atemwegsmanagement - Beatmung - Intubation - Rettungsmedizin

• Literatur

• 1 Dirks B. Sicherung der Atemwege in der Notfallmedizin. Stuttgart: Thieme; 2001
• 2 Timmermann A, Byhahn C, Wenzel V. et al. Handlungsempfehlung für das präklinische Atemwegsmanagement. Für Notärzte und Rettungsdienstpersonal. Anästh Intensivmed 2012; 53: 294-308
• 3 Soar J, Nolan JP, Bottiger BW. et al. European Resuscitation Council Guidelines for resuscitation 2015: section 3. Adult advanced life support. Resuscitation 2015; 95: 100-147
• 4 Timmermann A, Eich C, Russo SG. et al. Prehospital airway management: A prospective evaluation of anaesthesia trained emergency physicians. Resuscitation 2006; 70: 179-185
• 5 Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg 2004; 99: 607-613
• 6 Bernhard M, Mohr S, Weigand MA. et al. Developing the skill of endotracheal intubation: implication for emergency medicine. Acta Anaesthesiol Scand 2012; 56: 164-171
• 7 Komatsu R, Kasuya Y, Yogo H. et al. Learning curves for bag-and-mask ventilation and orotracheal intubation: an application of the cumulative sum method. Anesthesiology 2010; 112: 1525-1531
• 8 Johnston BD, Seitz SR, Wang HE. Limited opportunities for paramedic student endotracheal intubation training in the operating room. Acad Emerg Med 2006; 13: 1051-1055
• 9 Timmermann A, Braun U, Panzer W. et al. Präklinisches Atemwegsmanagement in Norddeutschland: Individuelle Kenntnisse, Vorgehen und Ausrüstung. Anaesthesist 2007; 56: 328-334
• 10 Association of Anaesthetists of Great Britain and Ireland. AAGBI Safety guideline pre-hospital anaesthesia. London: The Association of Anaesthetists of Great Britain and Ireland; 2009. Im Internet: https://www.aagbi.org/sites/default/files/prehospital_glossy09.pdf Stand: 13.04.2017
• 11 Timmermann A, Nickel EA, Puhringer F. Larynxmasken der zweiten Generation: Erweiterte Indikationen. Anaesthesist 2015; 64: 7-15
• 12 Timmermann A. Supraglottic airways in difficult airway management: successes, failures, use and misuse. Anaesthesia 2011; 66 (S2): 45-56
• 13 Cook TM, Howes B. Supraglottic airway devices: recent advances. Contin Educ Anaesth Crit Care Pain 2011; 2: 56-61
• 14 Russo SG, Wulf H. Advanced indications of the laryngeal mask – Limitations of use. Anasthesiol Intensivmed Notfallmed Schmerzther 2014; 49: 152-161
• 15 Timmermann A, Bergner UA, Russo SG. Laryngeal mask airway indications: new frontiers for second-generation supraglottic airways. Curr Opin Anaesthesiol 2015; 28: 717-726
• 16 Wenzel V, Idris AH, Banner MJ. et al. Influence of tidal volume on the distribution of gas between the lungs and stomach in the nonintubated patient receiving positive-pressure ventilation. Crit Care Med 1998; 26: 364-368
• 17 Ruben H, Knudsen EJ, Carugati G. Gastric inflation in relation to airway pressure. Acta Anaesthesiol Scand 1961; 5: 107-114
• 18 Bowman FP, Menegazzi JJ, Check BD. et al. Lower esophageal sphincter pressure during prolonged cardiac arrest and resuscitation. Ann Emerg Med 1995; 26: 216-219
• 19 Russo SG, Cremer S, Eich C. et al. Magnetic resonance imaging study of the in vivo position of the extraglottic airway devices i-gel and LMA-Supreme in anaesthetized human volunteers. Br J Anaesth 2012; 109: 996-1004
• 20 Schmidbauer W, Bercker S, Volk T. et al. Oesophageal seal of the novel supralaryngeal airway device I-Gel in comparison with the laryngeal mask airways Classic and ProSeal using a cadaver model. Br J Anaesth 2009; 102: 135-139
• 21 Russo SG, Stradtmann C, Crozier TA. et al. Bag-mask ventilation and direct laryngoscopy versus intubating laryngeal mask airway: a manikin study of hands-on times during cardiopulmonary resuscitation. Eur J Emerg Med 2014; 21: 189-194
• 22 Ruetzler K, Roessler B, Potura L. et al. Performance and skill retention of intubation by paramedics using seven different airway devices – a manikin study. Resuscitation 2011; 82: 593-597
• 23 Timmermann A, Russo SG, Crozier TA. et al. Novices ventilate and intubate quicker and safer via intubating laryngeal mask than by conventional bag-mask ventilation and laryngoscopy. Anesthesiology 2007; 107: 570-576
• 24 Hasegawa K, Hiraide A, Chang Y. et al. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA 2013; 309: 257-266
• 25 Benoit JL, Gerecht RB, Steuerwald MT. et al. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis. Resuscitation 2015; 93: 20-26
• 26 Taylor J, Black S, Brett J. et al. Design and implementation of the AIRWAYS-2 trial: A multi-centre cluster randomised controlled trial of the clinical and cost effectiveness of the i-gel supraglottic airway device versus tracheal intubation in the initial airway management of out of hospital cardiac arrest. Resuscitation 2016; 109: 25-32
• 27 Benoit JL, Prince DK, Wang HE. Mechanisms linking advanced airway management and cardiac arrest outcomes. Resuscitation 2015; 93: 124-127
• 28 Wang HE, Simeone SJ, Weaver MD. et al. Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation. Ann Emerg Med 2009; 54: 645-652
• 29 Cheskes S, Schmicker RH, Verbeek PR. et al. The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial. Resuscitation 2014; 85: 336-342
• 30 Weisfeldt ML, Becker LB. Resuscitation after cardiac arrest: a 3-phase time-sensitive model. JAMA 2002; 288: 3035-3038
• 31 Segal N, Yannopoulos D, Mahoney BD. et al. Impairment of carotid artery blood flow by supraglottic airway use in a swine model of cardiac arrest. Resuscitation 2012; 83: 1025-1030
• 32 Rasulo F, Zugni N, Piva S. et al. Influence of supraglottic airway device placement on cerebral hemodynamics. Minerva Anestesiol 2016; 82: 850-857
• 33 Gaither JB, Spaite DW, Bobrow BJ. et al. Balancing the potential risks and benefits of out-of-hospital intubation in traumatic brain injury: the intubation/hyperventilation effect. Ann Emerg Med 2012; 60: 732-736
• 34 Aufderheide TP, Sigurdsson G, Pirrallo RG. et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation 2004; 109: 1960-1965
• 35 Kilgannon JH, Jones AE, Shapiro NI. et al. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA 2010; 303: 2165-2171
• 36 Bernhard M, Gries A, Ramshorn-Zimmer A. et al. Insertion success of the laryngeal tube in emergency airway management. Biomed Res Int 2016; 2016: 3619159
• 37 Mann V, Mann ST, Alejandre-Lafont E. et al. Supraglottische Atemwegshilfen in der Notfallmedizin: Stellenwert der Magendrainage. Anaesthesist 2013; 62: 285-292
• 38 Schalk R, Seeger FH, Mutlak H. et al. Complications associated with the prehospital use of laryngeal tubes – a systematic analysis of risk factors and strategies for prevention. Resuscitation 2014; 85: 1629-1632
• 39 Bernhard M, Beres W, Timmermann A. et al. Prehospital airway management using the laryngeal tube. An emergency department point of view. Anaesthesist 2014; 63: 589-596
• 40 Hoffmann F, Keil J, Urban B. et al. Atemwegsmanagement mit supraglottischen Atemwegshilfen in der Kindernotfallmedizin. Anästh Intensivmed 2016; 57: 377-386
• 41 Byhahn C, Schalk R, Russo SG. Präklinische Atemwegssicherung. Drama in 5 Akten. Anaesthesist 2014; 63: 543-545
• 42 Russo SG, Cremer S, Galli T. et al. Randomized comparison of the i-gel^™, the LMA Supreme^™, and the Laryngeal Tube Suction-D using clinical and fibreoptic assessments in elective patients. BMC Anesthesiology 2012; 12: 18
• 43 Timmermann A. Supraglottic airways in difficult airway management: successes, failures, use and misuse. Anaesthesia 2011; 66 (Suppl. 02) 45-56