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Cluster cross-over randomised trial of paediatric airway management devices in the simulation lab and operating room among paramedic students
  1. Matthew Lee Hansen1,
  2. Adam Wagner2,
  3. Ashley Schnapp1,
  4. Amber Lin1,
  5. Nancy Le1,
  6. Sarah Deverman3,
  7. Elizabeth Pedigo3,
  8. Andrea Johnson3,
  9. Jordan Cusick3,
  10. Heike Gries3,
  11. Meredith Kato3
  1. 1Emergency Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
  2. 2Oregon Institute of Technology, Wilsonville, Oregon, United States
  3. 3Anesthesiology and Peri-operative Medicine, Oregon Health & Science University, Portland, Oregon, USA
  1. Correspondence to Dr Matthew Lee Hansen, Emergency Medicine, Oregon Health & Science University School of Medicine, Portland, OR 97239, USA; hansemat{at}ohsu.edu

Abstract

Objectives The objective of this study was to compare paediatric emergency airway management strategies in the simulation lab and operating room environments.

Methods This was a two-part cluster cross-over randomised trial including simulation lab and operating room environments conducted between January 2017 and June 2018 in Portland, Oregon, USA. In simulated infant cardiac arrests, paramedic students placed an endotracheal tube, an i-gel or a laryngeal mask airway in random order. In the operating room, paramedic students placed a laryngeal mask airway or i-gel device in random order in sequential patients. The primary outcome for both portions of the study was time to ventilation. In the operating room portion, we also evaluated leak pressures and average initial tidal volumes.

Results There were 58 paramedic students who participated in the simulation lab and 22 who participated in the operating room study. The mean time to airway placement in the simulation lab was 48.5 s for the i-gel, 68.9 s for the laryngeal mask and 129.5 s for the endotracheal tube. In the operating room, mean time to i-gel placement was 34.3 s with 45.2 s for the laryngeal mask. In multivariable analysis of the simulation study, the laryngeal mask and i-gel were significantly faster than the endotracheal tube, and the i-gel was faster than the laryngeal mask. In the operating room, there was no significant difference in time to placement, leak pressure and average volume of the first five breaths between the i-gel and laryngeal mask.

Conclusions We found that paramedic students were able to place supraglottic devices rapidly with high success rates in simulation lab and operating room environments. Supraglottic devices, particularly the i-gel, were rated as easy to use. The i-gel may be easiest to use since it lacks an inflable cuff and requires fewer steps to place.

  • airway
  • emergency ambulance systems
  • paediatric emergency med
  • paediatrics
  • paediatric resuscitation
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Footnotes

  • Handling editor Ellen J Weber

  • Contributors Matt Hansen contributed to obtaining the funding, design, collection of data, analysis, drafting the manuscript and critical revisions. Amber Lin contributed to the analysis of the data, drafted the revised methods and results sections of the manuscript, and made critical revisions to the entire manuscript. Nancy Le, Jordan Cusick, Andrea Johnson, Sarah Deverman, Elizabeth Pedigo, Merideth Kato, Adam Wagner, and Heike Gries contributed to obtaining the fcollection of data and critical revisions to the manuscript. All authors consent to the publication of this manuscript.

  • Funding This study was supported by the National Heart Lung and Blood Institute grant # K23 HL131440.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung and Blood Institute or the National Institutes of Health. In addition, Intersurgical, (Workingham, Berkshire, UK) provided i-gel® devices and Ambu, Columbia,MD provided AuraGain laryngeal mask devices for the study.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Oregon Health & Science University (OHSU) Institutional Review Board numbers 00016591 and 00016813.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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