The influence of different airway management strategies on chest compression fraction in simulated cardiopulmonary resuscitation, provided by paramedics: LMA Supreme versus Endotracheal Intubation and Combitube

Introduction. It is strongly advised by the European Resuscitation Council not to interrupt chest compressions for airway management. An alternative to tracheal intubation is the use of a supraglottic airway device (SAD) which should shorten “hands-off” time during cardiopulmonary resuscitation (CPR). Chest compression fraction (CCF) should be above 0.6 to ensure the probability of successful CPR. We compared the performance of airway management during CPR provided by paramedics using the laryngeal mask (LMA) Supreme, Combitube and endotracheal intubation (ET) in a manikin model. Materials and Methods. Thirty sophomore students of emergency medicine school for paramedics took part in the study. The primary endpoint was to assess the influence of the type of airway management on CCF. The time to successful airway management (TA) was measured and the minute ventilation was assessed using the respirator Medumat Easy and program AMBU® CPR SOFTWARE during uninterrupted CPR. CCF was measured using CPRmeter - QCPR (Laerdal). Results. Mean CCF was significantly better for LMA Supreme (0.8 vs 0.71 vs 0.65), mean TA was significantly shorter for LMA supreme: 16.5 sec vs 24.37 sec vs 28,3 sec, the success rate in the first attempt was 100% vs 66.6% vs 100%, mean air leak during chest compressions was 14% vs 8% vs 15% for LMA Supreme, ET and Combitube respectively. Conclusion. The LMA Supreme is an effective tool for airway management during chest compression and provides adequate ventilation

A Comparison of Performance of Endotracheal Intubation Using the Levitan FPS Optical Stylet or Lary-Flex Videolaryngoscope in Morbidly Obese Patients

Introduction. The use of videolaryngoscopes is recommended for morbidly obese patients. The aim of the study was to evaluate the Levitan FPS optical stylet (Levitan) vs Lafy-Flex videolaryngoscope (Lary-Flex) in a group of MO patients. Methods. Seventy-nine MO (BMI>40 kg m−2) patients scheduled for bariatric surgery were included in the study and randomly allocated to the Levitan FPS or Lary-Flex group. The primary endpoint was time to intubation and evaluation laryngoscopic of glottic view. Anesthesiologists were asked to evaluate the glottic view first under direct laryngoscopy using the videolaryngoscope as a standard laryngoscope (monitor display was excluded from use) and then using devices. The secondary endpoint was the cardiovascular response to intubation and the participant’s evaluation of such devices. Results. The time to intubation was 8.572.66 sec. versus 5.790.2 sec. for Levitan and Lary-Flex, respectively (P<0.05). In all cases of CL grade >1 under direct laryngoscopy, the study devices improved CL grade to 1. The Levitan FPS produced a greater cardiovascular response than the Lary-Flex videolaryngoscope. Conclusion. The Lary-Flex videolaryngoscope and the Levitan FPS optical stylet improve the laryngeal visualization in morbidly obese patients, allowing for fast endotracheal intubation, but Lary-Flex produces less cardiovascular response to intubation attempt

Thirty years of evolution of oral health behaviours and dental caries in urban and rural areas in Poland

[b]Introduction and objective[/b]. 34 years ago, children living in rural areas had almost 2 more teeth affected by decay than those living in cities. Environmental differences are being reduced along with Poland’s civilization development. The aim of the study is to assess the extent to which the differences in the intensity of caries and oral health behaviours between the urban rural environment have been reduced have been reduced in the past 3 decades. [b]Materials and methods[/b]. The data from 9 national surveys of 14,338 children aged 12 years and 5,425 adults aged 35–44 who lived in the city and in the countryside were analysed. Mean number of decayed (D), missing (M) and filled (F) teeth (DMFT) was determined during the examination, as well as oral health behaviours. [b]Results[/b]. During the past 3 decades, in the statistical 12-year-old Polish child, tooth decay has been reduced from 7.3 to 3.6 teeth, and the environmental difference between the town and village children is now almost 5 times smaller. A similar trend is observed in children’s dental behaviours. Improving the oral health status and levelling of the environmental differences in the population aged 35–44 is much slower than in children. [b]Conclusions[/b]. In the last three decades, the level of tooth decay has been reduced by half, but it is still 3 times higher than in other European countries. Environmental differences have been reduced particularly in children. Both the oral health status and urban/rural environment differences in the intensity of tooth decay may be regarded as one of the many measures of Poland’s social and civilization development. However, the analysed process is not monotonic; instead, it has some turning points

The Clarus Video System stylet for awake intubation in a very difficult urgent intubation

Awake fibreoptic intubation (AFI) is a standard method of airway management in a case of anticipated difficult intubation. It is usually performed using flexible fibroscopes. In this report, we describe the case of a 42 year-old female patient who suffered from congenital disease producing severe deformation of the head, face, neck and chest. In this case, the AFI procedure was performed successfully using a rigid intubation stylet: the Clarus Video System. One of the advantages of rigid stylets is that they are very easy to use, and in the hands of anaesthesiologists not very familiar with fibroscope intubation, they can be an alternative to flexible fibroscopes in AFI procedures.Awake fibreoptic intubation (AFI) is a standard method of airway management in a case of anticipated difficult intubation. It is usually performed using flexible fibroscopes. In this report, we describe the case of a 42 year-old female patient who suffered from congenital disease producing severe deformation of the head, face, neck and chest. In this case, the AFI procedure was performed successfully using a rigid intubation stylet: the Clarus Video System. One of the advantages of rigid stylets is that they are very easy to use, and in the hands of anaesthesiologists not very familiar with fibroscope intubation, they can be an alternative to flexible fibroscopes in AFI procedures

Endotracheal Intubation Using the Macintosh Laryngoscope or KingVision Video Laryngoscope during Uninterrupted Chest Compression

Objective. Advanced airway management, endotracheal intubation (ETI), during CPR is more difficult than, for example, during anesthesia. However, new devices such as video laryngoscopes should help in such circumstances. The aim of this study was to assess the performance of the KingVision video laryngoscopes in a manikin cardiopulmonary resuscitation (CPR) scenario. Methods. Thirty students enrolled in the third year of paramedic school took part in the study. The simulated CPR scenario was ETI using the standard laryngoscope with a Macintosh blade (MCL) and ETI using the KingVision video laryngoscope performed during uninterrupted chest compressions. The primary endpoints were the time needed for ETI and the success ratio. Results. The mean time required for intubation was similar for both laryngoscopes: 16.6 (SD 5.11, median 15.64, range 7.9–27.9) seconds versus 17.91 (SD 5.6, median 16.28, range 10.6–28.6) seconds for the MCL and KingVision, respectively (P=0.1888). On the first attempt at ETI, the success rate during CPR was comparable between the evaluated laryngoscopes: P=0.9032. Conclusion. The KingVision video laryngoscope proves to be less superior when used for endotracheal intubation during CPR compared to the standard laryngoscope with a Mackintosh blade. This proves true in terms of shortening the time needed for ETI and increasing the success ratio

Clinical Study A Comparison of Performance of Endotracheal Intubation Using the Levitan FPS Optical Stylet or Lary-Flex Videolaryngoscope in Morbidly Obese Patients

Introduction. The use of videolaryngoscopes is recommended for morbidly obese patients. The aim of the study was to evaluate the Levitan FPS optical stylet (Levitan) vs Lafy-Flex videolaryngoscope (Lary-Flex) in a group of MO patients. Methods. Seventynine MO (BMI &gt; 40kg m −2 ) patients scheduled for bariatric surgery were included in the study and randomly allocated to the Levitan FPS or Lary-Flex group. The primary endpoint was time to intubation and evaluation laryngoscopic of glottic view. Anesthesiologists were asked to evaluate the glottic view first under direct laryngoscopy using the videolaryngoscope as a standard laryngoscope (monitor display was excluded from use) and then using devices. The secondary endpoint was the cardiovascular response to intubation and the participant&apos;s evaluation of such devices. Results. The time to intubation was 8.572.66 sec. versus 5.790.2 sec. for Levitan and Lary-Flex, respectively ( &lt; 0.05). In all cases of CL grade &gt; 1 under direct laryngoscopy, the study devices improved CL grade to 1. The Levitan FPS produced a greater cardiovascular response than the Lary-Flex videolaryngoscope. Conclusion. The Lary-Flex videolaryngoscope and the Levitan FPS optical stylet improve the laryngeal visualization in morbidly obese patients, allowing for fast endotracheal intubation, but Lary-Flex produces less cardiovascular response to intubation attempt