Supraglottic airways and decreased carotid blood flow

[Asysin2leads]

Here's another study that I found interesting. http://www.ncbi.nlm.nih.gov/pubmed/22465807

What with all the sturm und drang (read: hoopla) about ET tubes and such, it seems that in porcine models in V-fib arrest with CPR in progress, placing a supraglottic airway significantly decreases the amount of carotid blood flow. That is, I think, really bad. Do you think this will have any ramifications on EMS practice? I doubt it. After all we found out back in 1978 that buccal glucose doesn't work but that didn't stop anybody.

[chbare]

Why should a single study that looks at 9 pigs make us change our current practice? I agree that additional studies are needed and would be very curious to see what happens in humans. Perhaps after we have a large amount of reproducible, peer review data, a paradigm shift will occur. However, we are not at that point now. Interesting find nonetheless.

[Kiwiology]

Interesting, I'm not even really convinced that positive pressure ventilation is required for a cardiac arrest patient, look at the studies from Arizona that show passive ventilation is linked to a better "outcomes" (I am not sure if it's ROSC or neurologically intact discharge)

[DwayneEMTP]

Hell, it only took 12 autistic kids to get the world to see vaccines as poison!

But point of course is taken...

[Kaisu]

Interesting, I'm not even really convinced that positive pressure ventilation is required for a cardiac arrest patient, look at the studies from Arizona that show passive ventilation is linked to a better "outcomes" (I am not sure if it's ROSC or neurologically intact discharge)

I believe those outcomes are attributed to continuous quality compressions

[Kiwiology]

I believe those outcomes are attributed to continuous quality compressions

That could very really be the case I would have to go look at the literature again and I can't be bothered right now

Either way I don't think artificial ventilation in cardiac arrest is really even necessary TBH but I that's only Level K evidence - opinion of Kiwi

Not to be confused with Special K - 2/3 of your daily fibre requirement and some nice dreams to boot now in 200mg/2ml RSI size!

[Bieber]

I attended a symposium by Dr. Gordon Ewy (the physician from Arizona who spearheaded CCR) and my take from it was that while the primary cause for decreased ROSC and survival to discharge neurologically intact was insufficient time on the chest due to compressions, intubation, transport, etc, there is also the hyperoxic toxicity at play as well.

As far as decreased carotid blood flow with supraglottic airways, I've heard that the combi-tube was bad about it but I haven't looked real deep into the literature myself. I can imagine how it COULD cause problems, with that massive balloon cuff, but like chbare noted, more studies are needed.

[DFIB]

I am still interested in the combination of supraglottics and ETT. I am not convinced that it needs to be one or the other. I am sure that there will be more studies to corroborate existing data.

Do any of you guys use the S.A.L.T. ?

[Bieber]

No. I've heard of it and seen the videos, it looks pretty sweet. I think we were talking about getting bougies, but I'm not sure if that's fallen through or not.

[WestMetroMedic]

The OPs cited study was completed at the hospital I work at and one of my medical directors is a principle on it.

We have adjusted our protocol slightly since this study was published but contrary to what you might think from the results of the study, we are still using the KingLTS in our practice. About two years ago, we were given the mandate that the KingLTS was to be the only airway we use in cardiac arrest for the simple fact that, agree with it or not, paramedics are generally not the best at intubation based simply on the fact that we don't have the muscle memory to be great at it (we employ 135 medics and each medic sees 1300 patients yearly), we should really take the results of OPALS and numerous other studies to heart and make the airway as simple and mindless as possible and based on the emerging literature, the KingLTS was that device.

as with any new product, testing of the product is paramount and based on this study and other findings at our service, the KingLTS is a decent airway, BUT it isn't prefect. Or new policy is to continue having our first responders place the KingLTS so that an airway is in place and the patient receives ventilation. A cardiac arrest patient will receive KingLTS therapy for 10 ish minutes while the majority of our cardiac arrest tasks are accomplished such as application of the LUCAS2, vascular access and initial airway management. After the brunt of tasks have been performed and med admin is the task at hand, we are then supposed to intubate our patient using a bougie seldinger method with the LUCAS2 running (which is actually very easy).

I generally like this method as it allows paramedics to continue being paramedics and still allows for decent outcomes based on the evidence we currently have but I suspect you can expect followup studies based on or experiences.

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