Verification of airway management during cardiac arrest: a manikin-based observational study.
BACKGROUND
The study aimed to clarify the difficulties concerning insertion of advanced airway devices during cardiac arrest.


METHODS
In an observational study using manikins, we examined the airway management techniques of 19 teams at the Osaka Senri medical rally. For ex-post verification, we recorded chest compression and ventilation using the Resusci Anne Advanced Skill Trainer (Laerdal, Norway) and recorded actions of the teams using a video camera.


RESULTS
Only a small proportion of teams did not adopt advanced airway management (4 teams, 21.1%). Thirteen teams selected tracheal intubation. None showed chest compression interruptions during intubation manipulation, and the median duration of chest compression interruption during confirmation of postintubation was 6.4 seconds. The median duration of ventilation interruption during intubation was 45.5 seconds. When teams were evaluated for the duration of direct laryngoscopy, that is, so-called duration of intubation, the median duration was 19 seconds, which constituted a large underestimate compared with the duration of ventilation interruption. This represents an underestimation of about 27 seconds. We considered the issues to be identified for shortening the duration of ventilation interruption.


CONCLUSIONS
From this study, it is clear that the strategy of Guideline 2005 that was designed to minimize chest compression interruption has permeated deeply. The recommendation that the duration of intubation manipulation should not exceed 30 seconds has had various interpretations, but it is important to focus on the duration of ventilation interruption.
Kobayashi
Masanao
M
Department of Emergency Medicine, Osaka Medical College Hospital, Takatsuki-city, Osaka 569-8686, Japan. emm003@poh.osaka-med.ac.jp
Fujiwara
Akira
A
Morita
Hiroshi
H
Nishimoto
Yasuhisa
Y
Mishima
Takayuki
T
Nitta
Masahiko
M
Hotta
Toshihiro
T
Hayashi
Toshimasa
T
Hayashi
Yasuyuki
Y
Sato
Kenji
K
D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D035641:Chest Wall Oscillation; D004635:Emergency Medicine / Q000592:standards; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal / Q000592:standards; D007828:Laryngoscopy / Q000592:standards; D008348:Manikins; D010348:Patient Care Team / Q000592:standards; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000592:standards; D013997:Time Factors