Re-evaluating of pre-hospital airway control : endotracheal and supraglottic airway adjuncts

Abstract

Pre-hospital airway management is a fundamental nursing skill, providing an artificial airway passage towards upper airway patency and security. For a number of years, tracheal intubation has been accepted to be the "golden standard" for advanced airway management. Nevertheless, the development of new, airway devices is reflecting upon the practice of advanced airway control, challenging conventional ways of managing a failing airway. Research question: In adult patients requiring airway control in the pre-hospital setting, how does endotracheal intubation compare to supraglottic airways with regards to morbidity, mortality, ease of inse1iion and skill retention? P- Adult patients over the age of 18, who require pre-hospital airway management. I- Endotracheal intubation C-Supraglottic airway adjuncts 0- Morbidity, mortality, ease of insertion and skill retention Methods of Appraisal: Use of a tailor-made appraisal kit strengthened by CASP tools. Results: Three academic databases were used for the literature search. Search te1ms were inse1ied into the databases. Inclusion and exclusion criteria were applied to the search results. A total of 101 studies were deemed to be related to the research question. Thorough appraisal of the content identified 18 studies that satisfied the Population, Intervention, Comparison and Outcome (PICO) of question consisting of 1 meta analysis, 1 systematic review, 10 observational studies and 6 randomized controlled trials. Conclusion: The Endotracheal tube offered maximal assurance with regards to prevention of aspiration but endured problems with inse1iion and skill retention. Certain types of supraglottic airways performed within a close margin to the tracheal tube in preventing regurgitation, airway trauma and providing effective ventilation. SGAs are easier to use and handle with durable skill retention. SGAs, predominantly the proseal laryngeal mask airway, the laryngeal tube and the combitube, had an overall very good perf 01mance. Implications and Recommendations: This disse11ation stirs recommendations on practical, managerial and education aspects. In addition, the need for more training in the use of supraglottic airways and the importance for fu11her research on alternative ways of pre-hospital airway management, were outlined.