title: Hands-off time during insertion of six airway devices during cardiopulmonary resuscitation: a randomised manikin trial.
abstract: BACKGROUND
  Cardiopulmonary resuscitation (CPR) guidelines recommend limiting interruptions of chest compressions because prolonged hands-off (i.e., non-compression) time compromises tissue perfusion. 2010 European Resuscitation Council guidelines suggest that chest compressions should be paused less than 10 s during airway device insertion.
  
  
  METHODS
  With approval of the local ethics committee of the Medical University of Vienna and written informed consent, we recruited 40 voluntary emergency medical technicians, none of whom had advanced airway management experience. After a standardised audio-visual lecture and practical demonstration, technicians performed airway management with each six airway devices (endotracheal tube, Combitube, EasyTube, laryngeal tube, Laryngeal Mask Airway, and I-Gel) during on-going chest compressions in a randomised sequence on a Resusci Anne Advanced Simulator. Data were analysed using a mixed-effects model accounting for the repeated measurements and pair-wise comparisons among the airway devices.
  
  
  RESULTS
  The hands-off time associated with airway management using an endotracheal tube (including all intubation attempts) was 48 s (95% confidence interval: 43-53). The hands-off time for airway management using a laryngeal tube was 8.4 (3.4-16.4) s, Combitube 10.0 (4.9-15.1) s, EasyTube 11.4 (6.4-16.4) s, LMA 13.3 (8.2-18.3) s and for I-Gel 15.9 (10.8-20.9) s. Hands-off time was significantly longer with the conventional endotracheal tube than with any of the other airway systems. Only a third of the technicians successfully inserted an endotracheal tube whereas all of them successfully positioned each supraglottic device.
  
  
  CONCLUSIONS
  Supraglottic devices appear to be a reasonable emergency airway management strategy, even for inexperienced personnel.
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Ruetzler
authors.forename: Christina
authors.initials: C
authors.lastname: Gruber
authors.forename: Sabine
authors.initials: S
authors.lastname: Nabecker
authors.forename: Philipp
authors.initials: P
authors.lastname: Wohlfarth
authors.forename: Anita
authors.initials: A
authors.lastname: Priemayr
authors.forename: Michael
authors.initials: M
authors.lastname: Frass
authors.forename: Oliver
authors.initials: O
authors.lastname: Kimberger
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.forename: Bernhard
authors.initials: B
authors.lastname: Roessler
mesh_terms: D000328:Adult; D058109:Airway Management / Q000592:standards*; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000592:standards; D017214:Laryngeal Masks / Q000592:standards; D008297:Male; D008348:Manikins; D011361:Professional Competence