Three Airway Management Techniques for Airway Decontamination in Massive Emesis: A Manikin Study
Introduction: Emesis occurs during airway management and results in pulmonary aspiration at rates of 0.01% – 0.11% in fasted patients undergoing general anesthesia and 0% – 22% in non-fasted emergency department patients. Suction-assisted laryngoscopy and airway decontamination (SALAD) involves mane...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2019-07-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/5qf2g8nm |
| _version_ | 1811285337590202368 |
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| author | Michael P. Fiore Steven L. Marmer Michael T. Steuerwald Ryan J. Thompson Richard E. Galgon |
| author_facet | Michael P. Fiore Steven L. Marmer Michael T. Steuerwald Ryan J. Thompson Richard E. Galgon |
| author_sort | Michael P. Fiore |
| collection | DOAJ |
| description | Introduction: Emesis occurs during airway management and results in pulmonary aspiration at rates of 0.01% – 0.11% in fasted patients undergoing general anesthesia and 0% – 22% in non-fasted emergency department patients. Suction-assisted laryngoscopy and airway decontamination (SALAD) involves maneuvering a suction catheter into the hypopharynx, while performing laryngoscopy and endotracheal intubation. Intentional esophageal intubation (IEI) involves blindly intubating the esophagus to control emesis before endotracheal intubation. Both are previously described techniques for endotracheal intubation in the setting of massive emesis. This study compares the SALAD and IEI techniques with the traditional approach of ad hoc, rigid suction catheter airway decontamination and endotracheal intubation in the setting of massive simulated emesis. Methods: Senior anesthesiology and emergency medicine (EM) residents were randomized into three trial arms: the traditional, IEI, or SALAD. Each resident watched an instructional video on the assigned technique, performed the technique on a manikin, and completed the trial simulation with the SALAD simulation manikin. The primary trial outcome was aspirate volume collected in the manikin’s lower airway. Secondary outcomes included successful intubation, intubation attempts, and time to successful intubation. We also collected pre- and post-simulation demographics and confidence questionnaire data. Results: Thirty-one residents (21 anesthesiology and 10 EM residents) were randomized. Baseline group characteristics were similar. The mean aspirate volumes collected in the lower airway (standard deviation [SD]) in the traditional, IEI, and SALAD arms were 72 (45) milliliters per liter (mL), 100 (45) mL, and 83 (42) mL, respectively (p = 0.392). Intubation success was 100% in all groups. Times (SD) to successful intubation in the traditional, IEI, and SALAD groups were 1.69 (1.31) minutes, 1.74 (1.09) minutes, and 1.74 (0.93) minutes, respectively (p = 0.805). Overall, residents reported increased confidence (1.0 [0.0–1.0]; P = 0.002) and skill (1.0 [0.0–1.0]; P < 0.001) in airway management after completion of the study. Conclusion: The intubation techniques provided similar performance results in our study, suggesting any one of the three can be employed in the setting of massive emesis; although this conclusion deserves further study. Residents reported increased confidence and skill in airway management following the experience, suggesting use of the manikin provides a learning impact. |
| first_indexed | 2024-04-13T02:42:40Z |
| format | Article |
| id | doaj.art-e7704f40aec44817ad1f66d463f4d788 |
| institution | Directory Open Access Journal |
| issn | 1936-9018 |
| language | English |
| last_indexed | 2024-04-13T02:42:40Z |
| publishDate | 2019-07-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-e7704f40aec44817ad1f66d463f4d7882022-12-22T03:06:09ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-90182019-07-0120510.5811/westjem.2019.6.42222wjem-20-784Three Airway Management Techniques for Airway Decontamination in Massive Emesis: A Manikin StudyMichael P. Fiore0Steven L. Marmer1Michael T. Steuerwald2Ryan J. Thompson3Richard E. Galgon4Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IllinoisDes Moines University, College of Osteopathic Medicine, Des Moines, IowaUniversity of Wisconsin School of Medicine and Public Health, Department of Emergency Medicine, Madison, WisconsinUniversity of Wisconsin School of Medicine and Public Health, Department of Emergency Medicine, Madison, WisconsinUniversity of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Madison, WisconsinIntroduction: Emesis occurs during airway management and results in pulmonary aspiration at rates of 0.01% – 0.11% in fasted patients undergoing general anesthesia and 0% – 22% in non-fasted emergency department patients. Suction-assisted laryngoscopy and airway decontamination (SALAD) involves maneuvering a suction catheter into the hypopharynx, while performing laryngoscopy and endotracheal intubation. Intentional esophageal intubation (IEI) involves blindly intubating the esophagus to control emesis before endotracheal intubation. Both are previously described techniques for endotracheal intubation in the setting of massive emesis. This study compares the SALAD and IEI techniques with the traditional approach of ad hoc, rigid suction catheter airway decontamination and endotracheal intubation in the setting of massive simulated emesis. Methods: Senior anesthesiology and emergency medicine (EM) residents were randomized into three trial arms: the traditional, IEI, or SALAD. Each resident watched an instructional video on the assigned technique, performed the technique on a manikin, and completed the trial simulation with the SALAD simulation manikin. The primary trial outcome was aspirate volume collected in the manikin’s lower airway. Secondary outcomes included successful intubation, intubation attempts, and time to successful intubation. We also collected pre- and post-simulation demographics and confidence questionnaire data. Results: Thirty-one residents (21 anesthesiology and 10 EM residents) were randomized. Baseline group characteristics were similar. The mean aspirate volumes collected in the lower airway (standard deviation [SD]) in the traditional, IEI, and SALAD arms were 72 (45) milliliters per liter (mL), 100 (45) mL, and 83 (42) mL, respectively (p = 0.392). Intubation success was 100% in all groups. Times (SD) to successful intubation in the traditional, IEI, and SALAD groups were 1.69 (1.31) minutes, 1.74 (1.09) minutes, and 1.74 (0.93) minutes, respectively (p = 0.805). Overall, residents reported increased confidence (1.0 [0.0–1.0]; P = 0.002) and skill (1.0 [0.0–1.0]; P < 0.001) in airway management after completion of the study. Conclusion: The intubation techniques provided similar performance results in our study, suggesting any one of the three can be employed in the setting of massive emesis; although this conclusion deserves further study. Residents reported increased confidence and skill in airway management following the experience, suggesting use of the manikin provides a learning impact.https://escholarship.org/uc/item/5qf2g8nm |
| spellingShingle | Michael P. Fiore Steven L. Marmer Michael T. Steuerwald Ryan J. Thompson Richard E. Galgon Three Airway Management Techniques for Airway Decontamination in Massive Emesis: A Manikin Study Western Journal of Emergency Medicine |
| title | Three Airway Management Techniques for Airway Decontamination in Massive Emesis: A Manikin Study |
| title_full | Three Airway Management Techniques for Airway Decontamination in Massive Emesis: A Manikin Study |
| title_fullStr | Three Airway Management Techniques for Airway Decontamination in Massive Emesis: A Manikin Study |
| title_full_unstemmed | Three Airway Management Techniques for Airway Decontamination in Massive Emesis: A Manikin Study |
| title_short | Three Airway Management Techniques for Airway Decontamination in Massive Emesis: A Manikin Study |
| title_sort | three airway management techniques for airway decontamination in massive emesis a manikin study |
| url | https://escholarship.org/uc/item/5qf2g8nm |
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