Anaesthesia 2014, 69, 343–347
doi:10.1111/anae.12545
Original Article A randomised crossover comparison of manikin ventilation through Soft Sealâ, i-gelTM and AuraOnceTM supraglottic airway devices by surf lifeguards K. Adelborg,1,2 R. H. Al-Mashhadi,3 L. H. Nielsen,4 C. Dalgas,3 M. B. Mortensen3 and B. Løfgren5,6 1 Senior House Officer, Department of Cardiology, 2 Senior House Officer, 5 Honorary Associate Professor, Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark 3 Research Fellow, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark 4 Senior House Officer, Department of Anaesthesiology, 6 Specialist Cardiology Registrar, Department of Internal Medicine, Regional Hospital of Randers, Randers, Denmark
Summary Forty surf lifeguards attempted to ventilate a manikin through one out of three supraglottic airways inserted in random order: the Portexâ Soft Sealâ; the Intersurgicalâ i-gelTM; and the Ambuâ AuraOnceTM. We recorded the time to ventilate and the proportion of inflations that were successful, without and then with concurrent chest compressions. The mean (SD) time to ventilate with the Soft Seal, i-gel and AuraOnce was 35.2 (7.2)s, 15.6 (3.3)s and 35.1 (8.5) s, respectively, p < 0.0001. Concurrent chest compression prolonged the time to ventilate by 5.0 (1.3–8.1)%, p = 0.0072. The rate of successful ventilations through the Soft Seal (100%) was more than through the AuraOnce (92%), p < 0.0001, neither of which was different from the i-gel (97%). The mean (SD) tidal volumes through the Soft Seal, i-gel and AuraOnce were 0.65 (0.14) l, 0.50 (0.16) l and 0.39 (0.19) l, respectively. Most lifeguards (85%) preferred the i-gel. Ventilation through supraglottic airway devices may be considered for resuscitation by surf lifeguards. .................................................................................................................................................................
Correspondence to: B. Løfgren Email: [email protected] Accepted: 20 November 2013
Introduction Drowning causes 400 000 fatalities each year [1]. Following submersion, asphyxia ultimately causes cardiac arrest [2]. Surf lifeguards provide the first links in the chain of survival, with outcome determined by the duration of hypoxia [3]. Several ventilation strategies, such as mouth-to-pocket mask, face-shield and bagvalve-mask, have been suggested: currently, mouthto-pocket mask ventilation is recommended by international lifeguard authorities [3, 4]. Supraglottic airways and can be used by staff unfamiliar with air© 2014 The Association of Anaesthetists of Great Britain and Ireland
way instrumentation. One study reported their successful use in 141/164 cardiac arrests by nurses [5]. We compared the time to ventilation and quality of ventilation by surf lifeguards using three supraglottic airway devices.
Methods We recruited surf lifeguards in active service, aged 18 years or more, from three Danish lifeguard organisations. All participants gave their consent. According to Danish law, we did not require approval from an 343
Anaesthesia 2014, 69, 343–347
Adelborg et al. | Use of supraglottic airways by surf lifeguards
ethical review committee. We recorded participants’ age, sex, certification year, occupation and previous basic life support training. We used recognised techniques to train participants for half an hour to use three supraglottic airway devices [6, 7]: the Portexâ Soft Sealâ Laryngeal Mask (Smiths Medical International Ltd, Ashford, Kent, UK); the i-gelTM Supraglottic Airway (Intersurgicalâ Ltd, Berkshire, UK); and the ‘AuraOnce’ Ambuâ AuraOnceTM (Ambu, Ballerup, Denmark). We randomly allocated each participant to insert the airways into a manikin (Ambu Cardiac Care Trainer System; Ambu), without and then with chest compressions (Fig. 1). Participants compressed a bag five times to ventilate the manikin (the BAG IITM Disposable Resuscitator; Laerdal, Stavanger, Norway). Participants scored airways with a five-point Likert scale after completing the task. Participants chose the airway they preferred and assessed their airway skills with a questionnaire.
(a)
We analysed data exported from the manikin, using a custom-made algorithm as previously described [8]. All sessions were video recorded. Two independent investigators recorded the time from participants’ touching the supraglottic airway device to manikin ventilation, which was judged successful if the chest inflated, and air leakage with one or more ventilations. We assessed whether the supraglottic airway devices were used correctly: gloves; cuff control; lubrication; head position; mouth insertion; pharyngeal insertion; cuff inflation; and use of the bag [6]. We analysed continuous data with a linear mixed model with systematic effects of airway, chest compressions (yes, no) and random surf lifeguard effect (PROC MIXED, SAS Institute Inc. SAS OnlineDocâ 9.1.3.; SAS Institute Inc, Cary, NC, USA). Time to ventilation was analysed on a log scale. Categorical variables were compared using McNemar’s test (QuickCalcs Online Calculators for Scientists) [9]. We
Assessed for eligibility (n = 42)
Declined to participate (n = 2)
Randomised (n = 40)
Soft Seal - i-gel - AuraOnce (n = 6)
AuraOnce - Soft Seal - i-gel (n = 5)
i-gel - Soft Seal - AuraOnce (n = 4)
Soft Seal - AuraOnce - i-gel (n = 13)
AuraOnce - i-gel - Soft Seal (n = 6)
i-gel - AuraOnce - Soft Seal (n = 6)
AuraOnce - i-gel - Soft Seal (n = 4)
i-gel - AuraOnce - Soft Seal (n = 8)
(b) Randomised (n = 40)
Soft Seal - i-gel - AuraOnce (n = 6)
AuraOnce - Soft Seal - i-gel (n = 5)
i-gel - Soft Seal - AuraOnce (n = 15)
Soft Seal - AuraOnce - i-gel (n = 2)
Figure 1 Flow chart showing inclusion of participants, the allocation sequence to the three different supraglottic airway devices and the two stages of randomisation, insertion of the airways without (a) and then with (b) ongoing chest compressions. 344
© 2014 The Association of Anaesthetists of Great Britain and Ireland
Adelborg et al. | Use of supraglottic airways by surf lifeguards
Anaesthesia 2014, 69, 343–347
considered two-tailed p values less than 0.05 as significant.
95% were able to ventilate: 5/40 preferred the Soft Seal, 34/40 the i-gel and 1/40 the AuraOnce.
Results
Discussion
Forty lifeguards (Fig. 1 and Table 1) required a median of one insertion attempt for all devices. Three participants failed to ventilate the manikin effectively, one through the i-gel and the other two through the AuraOnce. Figure 2 shows the time taken to ventilate and the generated tidal volumes. The mean (SD) time to ventilate with Soft Seal, i-gel and AuraOnce was 35.2 (7.2) s, 15.6 (3.3) s and 35.1 (8.5) s, respectively, p < 0.0001 for comparisons between the i-gel and other two airways. Concurrent chest compressions reduced the time to ventilate by 5 (1.3–8.1)%, p = 0.0072, without differences between supraglottic airway devices. The proportion of effective ventilations through the i-gel (97%) was not different from the other two airways, with the proportion of ventilations through the Soft Seal (100%) greater than through the AuraOnce (92%), p < 0.001. The mean (SD) tidal volumes through the Soft Seal, i-gel and AuraOnce were 0.65 (0.14) l, 0.50 (0.16) l and 0.39 (0.19) l, respectively, p < 0.0001 for comparisons between the i-gel and the other two airways. The rate of air leakage with the Soft Seal (2/40) was less than with the AuraOnce (17/40), p = 0.001, neither of which was statistically different from the rate with the i-gel (9/40). More than 90% of participants followed all recommended steps for inserting the airways. All participants stated that they were able to insert the airways and
Our main finding was that lifeguards can use supraglottic airway devices successfully in a manikin. Most lifeguards preferred the airway that they inserted fastest, the i-gel, in keeping with other studies [10]. Current international recommendations are for surf lifeguards to use mouth-to-pocket mask ventilation [3, 4]. Mouth-to-mouth ventilation has been demonstrated to reduce interruptions in chest compressions and improve quality of ventilations when compared to bag-valve-mask and mouth-to-pocket mask ventilation among surf lifeguards [8]. Supraglottic airway devices could help ventilation with concurrent chest compressions, potentially increasing survival after drowning. The trivial delay in ventilation caused by chest compressions would not justify their discontinuation, particularly as interruptions are associated with increased mortality [11]. The European Resuscitation Council Guidelines 2010 consider the Soft Seal, i-gel and AuraOnce equivalent [6]. We found that lifeguards generated tidal volumes that were too large or too small with the Soft Seal and AuraOnce, respectively, which probably reflected differences in leakage rather than differences in force of bag compression. Smaller or larger airways might have changed our results. Medical students generated tidal volumes within the advised range only 34% of the time when ventilating a manikin through a supraglottic airway [10]. Hypotension, gastric insufflation, regurgitation and aspiration might increase with ventilation force, problems that should be emphasised when training lifeguards in the future [12]. Both medical staff and lay people have reported similar rates of satisfaction with supraglottic airway devices [13–17]. Our manikin results may not be applicable to human resuscitation. However, in 65% of out-of-hospital cardiac arrests, paramedics successfully used supraglottic airways after only limited manikin training [15]. We did not assess gastric insufflation, bilateral lung ventilation or peak airway pressure. We did not assess skill retention, which might be satisfactory up to a year after training [10].
Table 1 Characteristics of 40 study Values are mean (SD) or number.
participants.
Item Age; years Female Surf lifeguard certification; year Surf lifeguard experience; years Healthcare professional Basic life support training within 3 years Educational level Sixth form college Craftsman Higher education (< 2 years) Higher education (2–5 years) Higher education (> 5 years)
24.7 (4.3) 11 2008 (4) 3.7 (4.1) 12 22 26 1 1 6 6
© 2014 The Association of Anaesthetists of Great Britain and Ireland
345
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Adelborg et al. | Use of supraglottic airways by surf lifeguards
60
60
Time (s)
(b) 80
Time (s)
(a) 80
40
20
40
20
0
0 Soft Seal
i-gel
AuraOnce
0.8
0.8 Tidal volume (L)
(d) 1.0
Tidal volume (L)
(c) 1.0
0.6
0.4
0.2
Soft Seal
i-gel
AuraOnce
Soft Seal
i-gel
AuraOnce
0.6
0.4
0.2
0.0
0.0 Soft Seal
i-gel
AuraOnce
Figure 2 Time to ventilation and tidal volume without (a and c) or with (b and d) ongoing chest compressions using the Soft Seal (●), i-gel (■) and AuraOnce (D). Horizontal bars are mean and SD. In conclusion, ventilation through supraglottic airway devices may be considered for resuscitation by surf lifeguards, although our findings should be confirmed in a clinical study.
This study was supported by the Institute of Clinical Medicine, Aarhus University, Aarhus University Hospital, The Christenson-Cesons Family Foundation and Regional Hospital of Randers.
Acknowledgements
Competing interests
We sincerely thank the Chief lifeguards of the North Zealand and Aalborg Surf Lifeguard Services, John Mogensen and Carsten Jørgensen, for their excellent collaboration. We are grateful to all the surf lifeguards who volunteered to participate in the study and we thank Torben Rehder and Daniel Bidstrup for their tremendous assistance. We thank the Department of Public Health, Section of Biostatistics, Aarhus University for their excellent help.
No external funding and no competing interests declared.
346
References 1. Injuries and violence prevention: non-communicable diseases and mental health: fact sheet on drowning. Geneva: World Health Organization, 2003. http://www.who.int/violence_ injury_prevention/other_injury/drowning/en/index.html (accessed 27/06/2012). 2. Berg RA. Role of mouth-to-mouth rescue breathing in bystander cardiopulmonary resuscitation for asphyxial cardiac arrest. Critical Care Medicine 2000; 28(11 Suppl): N193–5. © 2014 The Association of Anaesthetists of Great Britain and Ireland
Adelborg et al. | Use of supraglottic airways by surf lifeguards 3. Koster RW, Baubin MA, Bossaert LL, et al. European Resuscitation Council Guidelines for Resuscitation 2010. Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2010; 81: 1277–92. 4. International Lifesaving Federation. Statements on the use of oxygen by lifesavers. 2003. http://www.ilsf.org/sites/ilsf. org/files/filefield/medical_policy_08.pdf (accessed 27/06/ 2012). 5. Stone BJ, Leach AB, Alexander CA, et al. The use of the laryngeal mask airway by nurses during cardiopulmonary resuscitation. Results of a multicentre trial. Anaesthesia 1994; 49: 3–7. 6. Deakin CD, Nolan JP, Soar J, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 2010; 81: 1305–52. 7. Peyton JW. Teaching and Learning in Medical Practice. Great Britain: Manticore Europe Ltd., 1998. 8. Adelborg K, Dalgas C, Grove EL, Jørgensen C, Al-Mashhadi RH, Lofgren B. Mouth-to-mouth ventilation is superior to mouthto-pocket mask and bag-valve-mask ventilation during lifeguard CPR: a randomized study. Resuscitation 2011; 82: 618–22. 9. QuickCalcs Online Calculators for Scientists. http://www. graphpad.com/quickcalcs/mcnemar1.cfm (accessed 27/06/ 2012). 10. Fischer H, Hochbrugger E, Fast A, et al. Performance of supraglottic airway devices and 12 month skill retention: a ran-
© 2014 The Association of Anaesthetists of Great Britain and Ireland
Anaesthesia 2014, 69, 343–347
11.
12.
13.
14.
15.
16.
17.
domized controlled study with manikins. Resuscitation 2011; 82: 326–31. Edelson DP, Abella BS, Kramer-Johansen J, et al. Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation 2006; 71: 137–45. Aufderheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation 2004; 109: 1960–5. Wharton NM, Gibbison B, Gabbott DA, Haslam GM, Muchatuta N, Cook TM. I-gel insertion by novices in manikins and patients. Anaesthesia 2008; 63: 991–5. Adlam M, Purnell D. Supraglottic airway device preference and insertion speed in F1 doctors. Resuscitation 2012; 83: e129. Murray MJ, Vermeulen MJ, Morrison LJ, Waite T. Evaluation of prehospital insertion of the laryngeal mask airway by primary care paramedics with only classroom mannequin training. Canadian Journal of Emergency Medicine 2002; 5: 338–43. Alexander R, Chinery JP, Swales H, Sutton D. ‘‘Mouth to mouth ventilation’’: a comparison of the laryngeal mask airway with the Laerdal pocket facemask. Resuscitation 2009; 80: 1240– 3. Sch€alte G, Stoppe C, Aktas M, et al. Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011; 19: 60.
347
doi:10.1111/anae.12545
Original Article A randomised crossover comparison of manikin ventilation through Soft Sealâ, i-gelTM and AuraOnceTM supraglottic airway devices by surf lifeguards K. Adelborg,1,2 R. H. Al-Mashhadi,3 L. H. Nielsen,4 C. Dalgas,3 M. B. Mortensen3 and B. Løfgren5,6 1 Senior House Officer, Department of Cardiology, 2 Senior House Officer, 5 Honorary Associate Professor, Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark 3 Research Fellow, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark 4 Senior House Officer, Department of Anaesthesiology, 6 Specialist Cardiology Registrar, Department of Internal Medicine, Regional Hospital of Randers, Randers, Denmark
Summary Forty surf lifeguards attempted to ventilate a manikin through one out of three supraglottic airways inserted in random order: the Portexâ Soft Sealâ; the Intersurgicalâ i-gelTM; and the Ambuâ AuraOnceTM. We recorded the time to ventilate and the proportion of inflations that were successful, without and then with concurrent chest compressions. The mean (SD) time to ventilate with the Soft Seal, i-gel and AuraOnce was 35.2 (7.2)s, 15.6 (3.3)s and 35.1 (8.5) s, respectively, p < 0.0001. Concurrent chest compression prolonged the time to ventilate by 5.0 (1.3–8.1)%, p = 0.0072. The rate of successful ventilations through the Soft Seal (100%) was more than through the AuraOnce (92%), p < 0.0001, neither of which was different from the i-gel (97%). The mean (SD) tidal volumes through the Soft Seal, i-gel and AuraOnce were 0.65 (0.14) l, 0.50 (0.16) l and 0.39 (0.19) l, respectively. Most lifeguards (85%) preferred the i-gel. Ventilation through supraglottic airway devices may be considered for resuscitation by surf lifeguards. .................................................................................................................................................................
Correspondence to: B. Løfgren Email: [email protected] Accepted: 20 November 2013
Introduction Drowning causes 400 000 fatalities each year [1]. Following submersion, asphyxia ultimately causes cardiac arrest [2]. Surf lifeguards provide the first links in the chain of survival, with outcome determined by the duration of hypoxia [3]. Several ventilation strategies, such as mouth-to-pocket mask, face-shield and bagvalve-mask, have been suggested: currently, mouthto-pocket mask ventilation is recommended by international lifeguard authorities [3, 4]. Supraglottic airways and can be used by staff unfamiliar with air© 2014 The Association of Anaesthetists of Great Britain and Ireland
way instrumentation. One study reported their successful use in 141/164 cardiac arrests by nurses [5]. We compared the time to ventilation and quality of ventilation by surf lifeguards using three supraglottic airway devices.
Methods We recruited surf lifeguards in active service, aged 18 years or more, from three Danish lifeguard organisations. All participants gave their consent. According to Danish law, we did not require approval from an 343
Anaesthesia 2014, 69, 343–347
Adelborg et al. | Use of supraglottic airways by surf lifeguards
ethical review committee. We recorded participants’ age, sex, certification year, occupation and previous basic life support training. We used recognised techniques to train participants for half an hour to use three supraglottic airway devices [6, 7]: the Portexâ Soft Sealâ Laryngeal Mask (Smiths Medical International Ltd, Ashford, Kent, UK); the i-gelTM Supraglottic Airway (Intersurgicalâ Ltd, Berkshire, UK); and the ‘AuraOnce’ Ambuâ AuraOnceTM (Ambu, Ballerup, Denmark). We randomly allocated each participant to insert the airways into a manikin (Ambu Cardiac Care Trainer System; Ambu), without and then with chest compressions (Fig. 1). Participants compressed a bag five times to ventilate the manikin (the BAG IITM Disposable Resuscitator; Laerdal, Stavanger, Norway). Participants scored airways with a five-point Likert scale after completing the task. Participants chose the airway they preferred and assessed their airway skills with a questionnaire.
(a)
We analysed data exported from the manikin, using a custom-made algorithm as previously described [8]. All sessions were video recorded. Two independent investigators recorded the time from participants’ touching the supraglottic airway device to manikin ventilation, which was judged successful if the chest inflated, and air leakage with one or more ventilations. We assessed whether the supraglottic airway devices were used correctly: gloves; cuff control; lubrication; head position; mouth insertion; pharyngeal insertion; cuff inflation; and use of the bag [6]. We analysed continuous data with a linear mixed model with systematic effects of airway, chest compressions (yes, no) and random surf lifeguard effect (PROC MIXED, SAS Institute Inc. SAS OnlineDocâ 9.1.3.; SAS Institute Inc, Cary, NC, USA). Time to ventilation was analysed on a log scale. Categorical variables were compared using McNemar’s test (QuickCalcs Online Calculators for Scientists) [9]. We
Assessed for eligibility (n = 42)
Declined to participate (n = 2)
Randomised (n = 40)
Soft Seal - i-gel - AuraOnce (n = 6)
AuraOnce - Soft Seal - i-gel (n = 5)
i-gel - Soft Seal - AuraOnce (n = 4)
Soft Seal - AuraOnce - i-gel (n = 13)
AuraOnce - i-gel - Soft Seal (n = 6)
i-gel - AuraOnce - Soft Seal (n = 6)
AuraOnce - i-gel - Soft Seal (n = 4)
i-gel - AuraOnce - Soft Seal (n = 8)
(b) Randomised (n = 40)
Soft Seal - i-gel - AuraOnce (n = 6)
AuraOnce - Soft Seal - i-gel (n = 5)
i-gel - Soft Seal - AuraOnce (n = 15)
Soft Seal - AuraOnce - i-gel (n = 2)
Figure 1 Flow chart showing inclusion of participants, the allocation sequence to the three different supraglottic airway devices and the two stages of randomisation, insertion of the airways without (a) and then with (b) ongoing chest compressions. 344
© 2014 The Association of Anaesthetists of Great Britain and Ireland
Adelborg et al. | Use of supraglottic airways by surf lifeguards
Anaesthesia 2014, 69, 343–347
considered two-tailed p values less than 0.05 as significant.
95% were able to ventilate: 5/40 preferred the Soft Seal, 34/40 the i-gel and 1/40 the AuraOnce.
Results
Discussion
Forty lifeguards (Fig. 1 and Table 1) required a median of one insertion attempt for all devices. Three participants failed to ventilate the manikin effectively, one through the i-gel and the other two through the AuraOnce. Figure 2 shows the time taken to ventilate and the generated tidal volumes. The mean (SD) time to ventilate with Soft Seal, i-gel and AuraOnce was 35.2 (7.2) s, 15.6 (3.3) s and 35.1 (8.5) s, respectively, p < 0.0001 for comparisons between the i-gel and other two airways. Concurrent chest compressions reduced the time to ventilate by 5 (1.3–8.1)%, p = 0.0072, without differences between supraglottic airway devices. The proportion of effective ventilations through the i-gel (97%) was not different from the other two airways, with the proportion of ventilations through the Soft Seal (100%) greater than through the AuraOnce (92%), p < 0.001. The mean (SD) tidal volumes through the Soft Seal, i-gel and AuraOnce were 0.65 (0.14) l, 0.50 (0.16) l and 0.39 (0.19) l, respectively, p < 0.0001 for comparisons between the i-gel and the other two airways. The rate of air leakage with the Soft Seal (2/40) was less than with the AuraOnce (17/40), p = 0.001, neither of which was statistically different from the rate with the i-gel (9/40). More than 90% of participants followed all recommended steps for inserting the airways. All participants stated that they were able to insert the airways and
Our main finding was that lifeguards can use supraglottic airway devices successfully in a manikin. Most lifeguards preferred the airway that they inserted fastest, the i-gel, in keeping with other studies [10]. Current international recommendations are for surf lifeguards to use mouth-to-pocket mask ventilation [3, 4]. Mouth-to-mouth ventilation has been demonstrated to reduce interruptions in chest compressions and improve quality of ventilations when compared to bag-valve-mask and mouth-to-pocket mask ventilation among surf lifeguards [8]. Supraglottic airway devices could help ventilation with concurrent chest compressions, potentially increasing survival after drowning. The trivial delay in ventilation caused by chest compressions would not justify their discontinuation, particularly as interruptions are associated with increased mortality [11]. The European Resuscitation Council Guidelines 2010 consider the Soft Seal, i-gel and AuraOnce equivalent [6]. We found that lifeguards generated tidal volumes that were too large or too small with the Soft Seal and AuraOnce, respectively, which probably reflected differences in leakage rather than differences in force of bag compression. Smaller or larger airways might have changed our results. Medical students generated tidal volumes within the advised range only 34% of the time when ventilating a manikin through a supraglottic airway [10]. Hypotension, gastric insufflation, regurgitation and aspiration might increase with ventilation force, problems that should be emphasised when training lifeguards in the future [12]. Both medical staff and lay people have reported similar rates of satisfaction with supraglottic airway devices [13–17]. Our manikin results may not be applicable to human resuscitation. However, in 65% of out-of-hospital cardiac arrests, paramedics successfully used supraglottic airways after only limited manikin training [15]. We did not assess gastric insufflation, bilateral lung ventilation or peak airway pressure. We did not assess skill retention, which might be satisfactory up to a year after training [10].
Table 1 Characteristics of 40 study Values are mean (SD) or number.
participants.
Item Age; years Female Surf lifeguard certification; year Surf lifeguard experience; years Healthcare professional Basic life support training within 3 years Educational level Sixth form college Craftsman Higher education (< 2 years) Higher education (2–5 years) Higher education (> 5 years)
24.7 (4.3) 11 2008 (4) 3.7 (4.1) 12 22 26 1 1 6 6
© 2014 The Association of Anaesthetists of Great Britain and Ireland
345
Anaesthesia 2014, 69, 343–347
Adelborg et al. | Use of supraglottic airways by surf lifeguards
60
60
Time (s)
(b) 80
Time (s)
(a) 80
40
20
40
20
0
0 Soft Seal
i-gel
AuraOnce
0.8
0.8 Tidal volume (L)
(d) 1.0
Tidal volume (L)
(c) 1.0
0.6
0.4
0.2
Soft Seal
i-gel
AuraOnce
Soft Seal
i-gel
AuraOnce
0.6
0.4
0.2
0.0
0.0 Soft Seal
i-gel
AuraOnce
Figure 2 Time to ventilation and tidal volume without (a and c) or with (b and d) ongoing chest compressions using the Soft Seal (●), i-gel (■) and AuraOnce (D). Horizontal bars are mean and SD. In conclusion, ventilation through supraglottic airway devices may be considered for resuscitation by surf lifeguards, although our findings should be confirmed in a clinical study.
This study was supported by the Institute of Clinical Medicine, Aarhus University, Aarhus University Hospital, The Christenson-Cesons Family Foundation and Regional Hospital of Randers.
Acknowledgements
Competing interests
We sincerely thank the Chief lifeguards of the North Zealand and Aalborg Surf Lifeguard Services, John Mogensen and Carsten Jørgensen, for their excellent collaboration. We are grateful to all the surf lifeguards who volunteered to participate in the study and we thank Torben Rehder and Daniel Bidstrup for their tremendous assistance. We thank the Department of Public Health, Section of Biostatistics, Aarhus University for their excellent help.
No external funding and no competing interests declared.
346
References 1. Injuries and violence prevention: non-communicable diseases and mental health: fact sheet on drowning. Geneva: World Health Organization, 2003. http://www.who.int/violence_ injury_prevention/other_injury/drowning/en/index.html (accessed 27/06/2012). 2. Berg RA. Role of mouth-to-mouth rescue breathing in bystander cardiopulmonary resuscitation for asphyxial cardiac arrest. Critical Care Medicine 2000; 28(11 Suppl): N193–5. © 2014 The Association of Anaesthetists of Great Britain and Ireland
Adelborg et al. | Use of supraglottic airways by surf lifeguards 3. Koster RW, Baubin MA, Bossaert LL, et al. European Resuscitation Council Guidelines for Resuscitation 2010. Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2010; 81: 1277–92. 4. International Lifesaving Federation. Statements on the use of oxygen by lifesavers. 2003. http://www.ilsf.org/sites/ilsf. org/files/filefield/medical_policy_08.pdf (accessed 27/06/ 2012). 5. Stone BJ, Leach AB, Alexander CA, et al. The use of the laryngeal mask airway by nurses during cardiopulmonary resuscitation. Results of a multicentre trial. Anaesthesia 1994; 49: 3–7. 6. Deakin CD, Nolan JP, Soar J, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 2010; 81: 1305–52. 7. Peyton JW. Teaching and Learning in Medical Practice. Great Britain: Manticore Europe Ltd., 1998. 8. Adelborg K, Dalgas C, Grove EL, Jørgensen C, Al-Mashhadi RH, Lofgren B. Mouth-to-mouth ventilation is superior to mouthto-pocket mask and bag-valve-mask ventilation during lifeguard CPR: a randomized study. Resuscitation 2011; 82: 618–22. 9. QuickCalcs Online Calculators for Scientists. http://www. graphpad.com/quickcalcs/mcnemar1.cfm (accessed 27/06/ 2012). 10. Fischer H, Hochbrugger E, Fast A, et al. Performance of supraglottic airway devices and 12 month skill retention: a ran-
© 2014 The Association of Anaesthetists of Great Britain and Ireland
Anaesthesia 2014, 69, 343–347
11.
12.
13.
14.
15.
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