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Cluster cross-over randomised trial of paediatric airway management devices in the simulation lab and operating room
Matthew Lee Hansen1, Adam Wagner2, Ashley Schnapp3
1Emergency Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon, USA hansemat@ohsu.edu.
Insights
Paramedic students rapidly placed supraglottic airway devices, like the i-gel, in simulated and real pediatric emergencies. The i-gel demonstrated faster placement times compared to endotracheal tubes and laryngeal mask airways.
Area of Science:
- Emergency Medicine
- Paediatric Airway Management
- Medical Simulation
Background:
- Effective paediatric airway management is critical in emergency settings.
- Supraglottic airway devices offer an alternative to endotracheal intubation.
- Comparing device performance in simulation and real-world environments is essential.
Purpose of the Study:
- To compare the effectiveness of different paediatric emergency airway management strategies.
- To evaluate airway device performance in both simulation and operating room settings.
- To assess the time to ventilation and device placement success rates.
Main Methods:
- A two-part cluster cross-over randomized trial was conducted in simulation and operating room environments.
- Paramedic students used endotracheal tubes, i-gel, and laryngeal mask airways.
- Primary outcome was time to ventilation; secondary outcomes included leak pressures and tidal volumes.
Main Results:
- In simulation, i-gel placement was fastest (48.5s), followed by laryngeal mask (68.9s) and endotracheal tube (129.5s).
- In the operating room, i-gel (34.3s) and laryngeal mask (45.2s) placement times were not significantly different.
- Supraglottic devices were rated as easy to use, with i-gel potentially being the easiest.
Conclusions:
- Paramedic students achieved rapid and successful supraglottic device placement in both environments.
- The i-gel device, due to its design, may offer advantages in ease of use and speed.
- Findings support the use of supraglottic devices in paediatric emergency airway management.
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.
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