Larynxtubus-D (LT-D) und Larynxmaske (LMA)

Zusammenfassung

Hintergrund und Fragestellung: Eines der Ziele der aktuellen Leitlinien des European Resuscitation Council (ERC) zur Reanimation ist die Reduzierung der „No Flow Time” (NFT), also der summativen Zeit bei einer Reanimation, in der keine Thoraxkompressionen stattfinden. Die endotracheale Intubation soll nur noch durch in dieser Maßnahme erfahrenes Personal durchgeführt werden. Für unerfahrenes Personal werden dagegen verschiedene Alternativen zum Atemwegsmanagement empfohlen.

Methodik: Im Rahmen einer prospektiven randomisierten Studie wurden während eines Reanimationsszenarios zwei der durch den ERC als Alternative zur endotrachealen Intubation empfohlenen supraglottischen Atemwegshilfsmittel (Larynxtubus [LT-D] und Larynxmaske [LMA]) verglichen. Hierfür wurden 200 Rettungsassistenten randomisiert in zwei Gruppen eingeteilt (LT-Gruppe: Atemwegsmanagement mittels LT-D; LMA-Gruppe : Atemwegsmanagement mittels LMA). Die Reanimationssimulation erfolgte durch ein standardisiertes Szenario über 430 s. Studienendpunkte waren die summative NFT und die Effektivität der Beatmung am Simulator.

Ergebnisse: Die NFT wurde in der Simulationsstudie durch die Anwendung des LT-D im Vergleich zur LMA signifikant reduziert (104,2 s vs. 124,0 s; p < 0,01). 98 % der Teilnehmer konnten den LT-D im ersten Versuch platzieren. Dies gelang 74 % der Teilnehmer bei Nutzung der LMA. Der LT-D wurde am Phantom signifikant schneller erfolgreich platziert als die LMA (12,4 s vs. 29,1 s; p < 0,01). Während des simulierten Szenarios benötigten die Teilnehmer der LT-D-Gruppe 40,5 s bis zur ersten Ventilation des Simulators im Vergleich zur LMA-Gruppe (47,9 s).

Folgerung: Der LT-D überzeugte am Reanimationssimulator als alternatives Atemwegshilfsmittel in seiner Anwendung. Er stellt eine gute Alternative zur LMA im Rahmen des Atemwegsmanagements während einer Reanimationssituation dar.

Summary

Backround and objectives: In 2005 the European Resuscitation Council (ERC) published a revised version of the guidelines for Advanced Life Support (ALS). One of the aims was to reduce the time without chest compression in the first period of cardiac arrest. We evaluated in a manikin study whether using the single use laryngeal tube (LT-D) instead of single use laryngeal mask (LMA) for emergency airway management could reduce the „No Flow Time” (NFT). The NFT is defined as the time during which no chest compressions take place.

Methods: Randomised prospective study with 200 volunteers who performed a standardised simulated cardiac arrest management in a manikin following one-day cardiac arrest training (simulation scenario 430 s). Two supraglottic airway devices were compared (LT-D and LMA). Endpoints were the total „no flow time” during the scenario, and the successful airway management with the used airway device.

Results: In the present manikin study the use of the LT-D significantly reduced NFT compared with the LMA (104.2 s vs. 124.0 s; p < 0.01). The LT-D was correctly positioned by 98 % of the participants on the first attempt compared to 74 % with the LMA. The LT-D was inserted significantly faster than the LMA (12.4 s vs. 29.1 s, p < 0.01). During the cardiac arrest simulation establishing and performing first ventilation took an average of 40.5 s with the LT-D compared to 47.9 s with LMA.

Conclusions: In this manikin study data showed that the LT-D may be a good alternative airway device compared to LMA for providing and maintaining a patent airway during resuscitation.

Schlüsselwörter

Larynxtubus-D (LT-D) - Larynxmaske (LMA) - No Flow Time (NFT) - Herz-Lungen-Wiederbelebung - Atemwegstraining

Keywords

Laryngeal Tube-D (LT-D) - Classic Laryngeal Mask (LMA) - No Flow Time (NFT) - Cardiopulmonary resuscitation (CPR) - Airway management

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