|Segnalazioni dalla letteratura|
Atherton GL, Johnson JC.
Ability of paramedics to use the Combitube in prehospital cardiac arrest. - Ann Emerg Med. 1993 Aug;22(8):1263-8.
STUDY OBJECTIVE: To evaluate the ability of paramedics in a nonurban emergency medical services
system to use the Combitube, a combined endotracheal and esophageal obturator airway adjunct, in
prehospital cardiac arrest patients. DESIGN: A prospective, controlled study to evaluate the difficulty and
complications of insertion, recognition of esophageal versus tracheal placement, skill proficiency, and
retention. The ability to use the device in cases of failed endotracheal intubation also was scrutinized.
SETTING: Evaluation of the paramedic's ability to use the Combitube was performed in a prehospital
environment. A follow-up study to determine retention of insertion skill was conducted in a controlled
laboratory setting. INTERVENTIONS: Fifty-two cases of paramedic prehospital Combitube insertion were
examined, and 11 paramedics were evaluated for skill retention. MEASUREMENTS AND MAIN
RESULTS: Combitube insertion was attempted on 52 prehospital patients in cardiac arrest, and 69% were
intubated successfully. Paramedics recognized esophageal versus tracheal placement in 100% of the cases.
The Combitube was inserted successfully into 64% of the patients who could not be endotracheally
intubated by the conventional visualized method. The Combitube was inserted successfully 71% of the time
when used as a first-line airway adjunct. A follow-up study on 11 randomly selected paramedics involved
in the field study was conducted 15 months later. Nine of 11 paramedics demonstrated inadequate skill
retention in the follow-up study. CONCLUSION: Although visualized endotracheal intubation remains the
preferred method of airway control, the Combitube may be an effective prehospital airway device as both a
backup to the endotracheal tube and a primary airway. Although the Combitube does not require
visualization with a laryngoscope, comprehensive training and continuing education are key factors
affecting skill retention.
PMID: 8333625, UI: 93325851
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