Richard Schalk1, Florian H Seeger2, Haitham Mutlak1, Uwe Schweigkofler3, Kai Zacharowski1, Norman Peter1, Christian Byhahn4. 1. Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy; Goethe-University Hospital, Frankfurt, Germany. 2. Department of Cardiology, Internal Medicine III, Goethe-University Hospital, Frankfurt, Germany. 3. Department of Orthopaedics and Trauma Surgery, BG Unfallklinik, Frankfurt, Germany. 4. Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy; Goethe-University Hospital, Frankfurt, Germany; Medical Campus University of Oldenburg, European Medical School, Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus, Oldenburg, Germany. Electronic address: christian.byhahn@uni-oldenburg.de.
Abstract
OBJECTIVE: With the increasing spread of laryngeal tubes (LT) in emergency medicine, complications and side-effects are observed. We sought to identify complications associated with the use of LTs in emergency medicine, and to develop strategies to prevent these incidents. METHODS: In a prospective clinical study, all patients who had their airways managed in the field with a LT and who were admitted through the emergency department of the Frankfurt University Hospital during a 6 year period were evaluated using anonymised data collection sheets. A team of experts was available 24/7 and was requested whenever a patient was admitted with a LT in place. This team evaluated the condition of the patients with respect to prehospital airway management and was responsible for further advanced airway management. All complications were analysed, and strategies for prevention developed. RESULTS: One hundred eighty nine patients were included and analysed. The initial cuff pressure of the LTs was 10 0 cm H₂O on the median. Complications consisted of significant tongue swelling (n=73; 38.6%), resulting in life-threatening cannot ventilate, cannot intubate scenarios in two patients (1.0%) and the need for surgical tracheostomy in another patient, massive distension of the stomach (n=20, 10.6%) with ventilation difficulties when LTs without gastric drainage were used; malposition of the LT in the piriform sinus (n=1, 0.5%) and significant bleeding from soft tissue injuries (n=4, 2.1%). CONCLUSIONS: The prehospital use of LTs may result in severe and even life-threatening complications. Likely, such complications could have been prevented by using gastric drainage and cuff pressure adjustment. Both, prehospital health care providers and emergency department staff should develop a greater awareness of such complications to best avoid them in the future.
OBJECTIVE: With the increasing spread of laryngeal tubes (LT) in emergency medicine, complications and side-effects are observed. We sought to identify complications associated with the use of LTs in emergency medicine, and to develop strategies to prevent these incidents. METHODS: In a prospective clinical study, all patients who had their airways managed in the field with a LT and who were admitted through the emergency department of the Frankfurt University Hospital during a 6 year period were evaluated using anonymised data collection sheets. A team of experts was available 24/7 and was requested whenever a patient was admitted with a LT in place. This team evaluated the condition of the patients with respect to prehospital airway management and was responsible for further advanced airway management. All complications were analysed, and strategies for prevention developed. RESULTS: One hundred eighty nine patients were included and analysed. The initial cuff pressure of the LTs was 10 0 cm H₂O on the median. Complications consisted of significant tongue swelling (n=73; 38.6%), resulting in life-threatening cannot ventilate, cannot intubate scenarios in two patients (1.0%) and the need for surgical tracheostomy in another patient, massive distension of the stomach (n=20, 10.6%) with ventilation difficulties when LTs without gastric drainage were used; malposition of the LT in the piriform sinus (n=1, 0.5%) and significant bleeding from soft tissue injuries (n=4, 2.1%). CONCLUSIONS: The prehospital use of LTs may result in severe and even life-threatening complications. Likely, such complications could have been prevented by using gastric drainage and cuff pressure adjustment. Both, prehospital health care providers and emergency department staff should develop a greater awareness of such complications to best avoid them in the future.
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Authors: J W Erath; A Reichert; S Büttner; H Weiler; M Vamos; B von Jeinsen; S Heyl; R Schalk; H Mutlak; A M Zeiher; S Fichtlscherer; J Honold Journal: Med Klin Intensivmed Notfmed Date: 2019-06-13 Impact factor: 0.840