Airway managment during CPR - SYMPOMED...Airway managment during CPR Stefano Malinverni MD CHU Saint...
Transcript of Airway managment during CPR - SYMPOMED...Airway managment during CPR Stefano Malinverni MD CHU Saint...
Airway managment
during CPRStefano Malinverni MD
CHU Saint Pierre
Conflicts of interests
• I am a believer
of ET
ET DURING CPR
Advanced airway management
• Minimize complications
• Minimize no flow time
• Minimize interruptions of chest compressions
• Protect against inhalation
• Guarantee oxygenation despite altered chest
compliance and pulmonary epithelium
• Increase cardiac output
• Increase chances of ROSC and intact neurological
survival
Gold standard?
Theoretical advantages
• Reduces no flow time by suppressing ventilation
associated pauses
• Reduces the number of chest compression pauses
• Reduces inhalation risk
• Reduces gastric insufflation
• Less risks of airway displacement
• Allows for an impedance valve use
• Allows continuous ETCO2 monitoring
• Endotracheal intubation and
laryngeal mask both
significantly reduce NO-flow
time by allowing continuous
chest compressions
• Endotracheal intubation and
laryngeal mask both
significantly reduce NO-flow
time by allowing continuous
chest compressions
Endotracheal tube
placement in practice
Endotracheal tube placement
in theory (in the OR)
• Up to 9
intubation
attempts during
ALS with a
median of 2
attempts per ALS.
• The median time of
chest compression
interruption during
the first intubation
attempt was 47
seconds.
• The median total time
of chest compressions
interruptions to place
an endotracheal tube
was 110 seconds.
Failure1st attempt No failure
• 85% of endotracheal tube
placements needed less than 2
attempts
• 7.5% of endotracheal tube
placements needed 3 or more
attempts
• 7.5% of attempts never
succeeded
TUBE
TUBE
IS SCIENTIFIC EVIDENCE IN
FAVOUR OF OR AGAINST
ROUTINE ENDOTRACHEAL
INTUBATION DURING CPR?
TUBE
TUBE
• PARAMEDIC based system with obligation to
admit to hospital every cardiac arrest.
ROSC
LT
Survival with
CPC 1-2
ET vs Bag Valve mask(propensity score matched)
ET placement within 15 min vs after• ROSC 59.3 vs 57.8 . Survival with CPC 1-2 13.6 vs 10.6
• Survie sortie hôpital RR 0.84
• Outcome neurologiquement favorable RR 0.78
• ROSC 59.3%: (BMV) vs 57.8% (immediate ET placement) RR 0.96
• Hospital discharge: 19.4% (BMV) vs 16.3% (immediate ET placement)
RR 0.84
• Favourable neurological outcome: 13.6% (BMV) vs 10.6% (immediate
ET placement) RR 0.78
0
5
10
15
BMV ETI
CPC 1-2
BMV
ETI13.610.6
Supraglottic
devices?
TUBE
TUBE
•Survival with favourable
neurological outcome
• Theoretical advantages of ET placement
but
• Empirical scientific evidence is not in
favour of routine ET placement during
cardiac arrest.
ER doctor
TUBE
TUBE
ET placement only if experienced, without
any interruption and after implementing
high quality CPR and early defibrillation.
•ROSC
•Survie jusqu’à l’admission
SGD réduisent la probabilité
d’outcome favorable
Toujours confirmer placement
du tube par capnographie
• Intubation trachéale n’a jamais démontré une supériorité par rapport au masque ballon pendant la CPR
• Si décision de placement de TE:• Sans pauses de massage• Par operateur expérimenté• Toujours confirmé par capnographie• Aide par vidéo-laryngoscopie?
• Preuves de infériorité des moyens Supra-glottiques• A garder pour échecs ventilation masque
ballon / échecs intubation