Nicolas PESCHANSKI, MD, PhD
Emergency Physician. FOAMed Supporter
Research Manager. Emergency Department, SAMU and MICU
Evreux Eure-Seine General Hospital. Normandy, France
Welcome to our annual review of the best articles from the past year.
This will be a weekly (or so..) appointment with the top (or so…) articles of 2017 divided by topic and chosen by me.
At the end of the post I will also mention some take home points as summary of the evidences emerged from the articles.
And now here is the best (for me) about:
Here are the best articles of the past year about Airway Management:
- Cardiac Arrest and Mortality Related to Intubation Procedure in Critically Ill Adult Patients: A Multicenter Cohort Study
- Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis
- Intubation using apnoeic oxygenation to prevent desaturation: A systematic review and meta-analysis
- Effectiveness of Apneic Oxygenation During Intubation: A Systematic Review and Meta-analysis
- A prospective, randomised trial of pre-oxygenation strategies available in the pre-hospital environment
- Maintenance of Oxygenation during Rapid Sequence Intubation in the Emergency Department
- Direct Versus Video Laryngoscopy for Prehospital Intubation: A Systematic Review and Meta-analysis
- Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane Systematic Review
- Prehospital Intubation is Associated with Favorable Outcomes and Lower Mortality in ProTECT IIIP
- The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis
- Pre-hospital Supraglottic Airway was Associated with Good Neurological Outcome in Cardiac Arrest Victims Especially Who Received Prolonged Cardiopulmonary Resuscitation.
- Theeffectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study
- Avoidance versus use of neuromuscular blocking agents for improving conditions during tracheal intubation or direct laryngoscopy in adults and adolescents (Cochrane review)
- The Impact of Prehospital Intubation With and Without Sedation on Outcome in Trauma Patients With a GCS of 8 or Less
- Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review
- Effect of patient weight on first pass success and neuromuscular blocking agent dosing for rapid sequence intubation in the emergency department
- Cuffed vs. uncuffed tracheal tubes in children: a randomised controlled trial comparing leak, tidal volume and complications
- Managing Initial Mechanical Ventilation in the Emergency Department
- The myth of the difficult airway: airway management revisited
- Strategies for the prevention of airway complications – a narrative review
- Airway Management in Trauma
My take home messages about airway management:
- Risk factorsfor intubation related cardiac arrest are: overweight or obesity, age more than 75 years old, low SBP prior to intubation, hypoxemia prior to intubation, and absence of preoxygenation before intubation procedure.
- Preoxygenationis crucial (at least 2 minutes), before paralysing, to extend safe apnea time.
- Use apneic oxygenationduring intubation attempts.
- Tracheal intubationis good in the hands of very well skilled professionals. Otherwise can improve mortality rate.
- Supraglottic devicesperform well in cardiac arrest and are a valuable option for airway management.
- Videolaryngoscopyimprove glottic view but need training to improve first pass success.
- Always use paralyticswhen intubating a non-cardiac arrest patient. It improves the chances fo first pass success.
- Rocuronium and Succynocholineare both valuable options for paralysis in airway management.
- Dose Succynocholine,and other depolarising neuromuscular blockade drugs, based on actual body weight. Dose Rocuronium or Vecuronium based on ideal body weight.
- Use cuffed tracheal tubes even in paediatric They perform well and complications rate is the same.
- The difficult airway is a myth. It’s not a matter of technique but of decision making.