title: Evaluation of airway management associated hands-off time during cardiopulmonary resuscitation: a randomised manikin follow-up study.
abstract: BACKGROUND
  Airway management is an important component of cardiopulmonary resuscitation (CPR). Recent guidelines recommend keeping any interruptions of chest compressions as short as possible and not lasting more than 10 seconds. Endotracheal intubation seems to be the ideal method for establishing a secure airway by experienced providers, but emergency medical technicians (EMT) often lack training and practice. For the EMTs supraglottic devices might serve as alternatives.
  
  
  METHODS
  40 EMTs were trained in a 1-hour standardised audio-visual lesson to handle six different airway devices including endotracheal intubation, Combitube, EasyTube, I-Gel, Laryngeal Mask Airway and Laryngeal tube. EMTs performances were evaluated immediately after a brief practical demonstration, as well as after 1 and 3 months without any practice in between, in a randomised order. Hands-off time was pair-wise compared between airway devices using a repeated-measures mixed-effects model.
  
  
  RESULTS
  Overall mean hands-off time was significantly (p<0.01) lower for Laryngeal tube (6.1s; confidence interval 5.2-6.9s), Combitube (7.9s; 95% CI 6.9-9.0s), EasyTube (8.8s; CI 7.3-10.3s), LMA (10.2s; CI 8.6-11.7s), and I-Gel (11.9s; CI 10.2-13.7s) compared to endotracheal intubation (39.4s; CI 34.0-44.9s). Hands-off time was within the recommended limit of 10s for Combitube, EasyTube and Laryngeal tube after 1 month and for all supraglottic devices after 3 months without any training, but far beyond recommended limits in all three evaluations for endotracheal intubation.
  
  
  CONCLUSIONS
  Using supraglottic airway devices, EMTs achieved a hands-off time within the recommended time limit of 10s, even after three months without any training or practice. Supraglottic airway devices are recommended tools for EMTs with lack of experience in advanced airway management.
authors: Department of General Anaesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria.
authors: Christina
authors: C
authors: Gruber
authors: Sabine
authors: S
authors: Nabecker
authors: Philipp
authors: P
authors: Wohlfarth
authors: Anita
authors: A
authors: Ruetzler
authors: Dominik
authors: D
authors: Roth
authors: Oliver
authors: O
authors: Kimberger
authors: Henrik
authors: H
authors: Fischer
authors: Michael
authors: M
authors: Frass
authors: Kurt
authors: K
authors: Ruetzler
mesh_terms: D000328:Adult; D060666:Airway Extubation / Q000295:instrumentation / Q000379:methods; D058109:Airway Management / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D001296:Audiovisual Aids; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D016001:Confidence Intervals; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008348:Manikins; D055815:Young Adult