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Comparison of three airway management techniques in a simulated tactical setting.

机译：在模拟战术环境中比较三种气道管理技术。

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INTRODUCTION: Several different methods for emergent airway management are feasible in the tactical environment. Current studies fail to identify which method minimizes the exposure of the tactical medic or which is most rapid with the greatest chance of first-attempt success. METHODS: We evaluated three commonly used airway management techniques, including standard direct laryngoscopy with endotracheal intubation, digital endotracheal intubation, and use of the King LT laryngotracheal airway device. Study participants were volunteer emergency medicine (EM) residents and medical flight crew members with difficult airway management skills. We compared the times to successful ventilation, numbers of attempts to successful ventilation, and heights of presentation of the participants above a barricade used to simulate concealment. RESULTS: Thirty-one subjects completed the study, of whom 12 (39%) were medical flight crew members and 19 (61%) were EM residents. All subjects were able to successfully ventilate manikins using each of the three methods. The mean number of attempts to intubate and ventilate the manikin was 1.03 for direct laryngoscopy, 1.26 for the King LT, and 1.67 for digital endotracheal intubation. Mean time to ventilation was 59.7 seconds for the King LT, 63.3 seconds for laryngoscopy, and 125.4 seconds for digital intubation. The maximum height the medic reached above the barricade during airway management was 17.7 inches for the King LT, 19.7 inches for laryngoscopy, and 23.5 inches for digital intubation. Comparison of all three factors across groups showed significance, with the exception of time to ventilation between laryngoscopy and use of the King LT. CONCLUSION: In a simulated tactical airway management scenario, use of the King LT provided less exposure than digital or standard endotracheal intubation techniques. Digital intubation behind the simulated barricade was the least successful by all measures. Although direct laryngoscopy was the most successful on the first attempt, use of the King LT in our scenario provided the least exposure of the medic and was as effective as direct laryngoscopy with regard to time to ventilation. Key words: TEMS; airway management; simulation; tactical environment; combat medicine.
机译：简介：在战术环境中，几种用于紧急气道管理的不同方法是可行的。当前的研究未能确定哪种方法可以最大程度地减少战术医务人员的暴露，或者哪种方法最快，首次尝试成功的可能性最大。方法：我们评估了三种常用的气道管理技术，包括采用气管内插管的标准直接喉镜检查，数字气管内插管和使用King LT喉气管气道装置。研究参与者为志愿者急救医学（EM）居民和呼吸道管理技能较差的医疗飞行机组人员。我们将通气的时间，通气的尝试次数以及参与者在用来掩饰的路障上方的演讲高度进行了比较。结果：31名受试者完成了研究，其中12名（39％）是医疗飞行机组人员，19名（61％）是EM居民。所有受试者均能够使用三种方法中的每一种成功地使人体模型通风。对于直接喉镜，对人体模型进行插管和通气的平均尝试次数为1.03，对King LT进行尝试的平均次数为1.26，对于气管内插管的尝试次数为1.67。 King LT的平均通气时间为59.7秒，喉镜检查的平均通气时间为63.3秒，数字插管的平均通气时间为125.4秒。在气道处理过程中，医生在路障上方达到的最大高度对于King LT为17.7英寸，对于喉镜检查为19.7英寸，对于数字插管为23.5英寸。除喉镜检查和使用King LT之间的通气时间外，各组中所有这三个因素的比较均具有重要意义。结论：在模拟战术气道管理方案中，与数字或标准气管插管技术相比，King LT的使用减少了暴露。在所有方面，模拟路障后面的数字插管都是最不成功的。尽管直接喉镜是首次尝试最成功的方法，但在我们的方案中使用King LT可以使医疗人员的暴露最少，并且就通气时间而言与直接喉镜一样有效。关键字：TEMS;气道管理;模拟;战术环境;战斗医学。

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