Abstract
Background Skiing is a high-risk winter sport, and the rate of injury fatality is the highest compared to other winter sports. During skiing rescue, the harsh natural environments will increase the difficulty of artificial airway establishment. There has been no research focusing on the establishment of the artificial airway during skiing rescue site. This study aims to simulate the real-world scenario, calculating and comparing the operation time of different artificial airways on the cold slope, and to explore the optimal method of establishing artificial airway on the cold slope, sharing our experience, technical notes, and pitfalls we encountered, hoping to help establish a standard operating procedure in advanced airway management on the ski slope. Methods The simulated human was placed on the cold slope with the head under the feet. Artificial airway was established by the same anesthesiologist using endotracheal intubation (endotracheal intubation group), LMA Supreme laryngeal mask (LMA group), and I-gel laryngeal mask (I-gel group). Each method was repeated 5 times, and the operation time and whether it was successful by one attempt were recorded and compared between groups. Results Three groups of artificial airway were successful by one attempt.. The bite block dropped and drifted away for one time in the endotracheal intubation group. Operation time is 209.2 ± 32.7 seconds in the endotracheal intubation group, 72.2 ± 3.1 seconds in the LMA group, and 52.6 ± 4.2 seconds in the I-gel group. ANOVA showed that there was a significant difference in the operation time among the three groups (p < 0.001). Tukey's post hoc test showed that there were statistically significant differences between the endotracheal intubation group and the other two groups in operation time, p < 0.001, while there was no significant difference between the LMA group and I-gel group (p=0.275). Conclusion The artificial airway can be completed by endotracheal intubation and LMA and I-gel laryngeal mask insertion on the cold slope. Artificial airway with the I-gel laryngeal mask takes the shortest time in this study. Extra caution should be paid to slippery and drifting.
Highlights
Skiing is a high-risk winter sport, and the rate of injury fatality is the highest compared to other winter sports
There has been no research focusing on the establishment of artificial airway during skiing rescue site. is study aims to simulate the real-world scenario, calculating and comparing the operation time of different artificial airways on the cold slope, and to explore the optimal method of establishing artificial airway on the cold slope, sharing our experience, technical notes, and pitfalls we encountered, hoping to help establish a standard operating procedure in advanced airway management on the ski slope
(5) Protocol: a 5 ∗ 5 m area was cleared and secured. e simulator was placed inside the area, at the supine position, with the head towards the downhill direction. e participant tried to establish artificial airway, respectively, by endotracheal intubation assisted with the video laryngoscope, Laryngeal mask airway FIS (LMA) Supreme laryngeal mask insertion (LMA group), and I-gel laryngeal mask insertion (I-gel group)
Summary
Skiing is a high-speed and high-risk winter sport driven by gravity and slope, and the rate of injury fatality is the highest compared to other winter sports. A total of 369 deaths were recorded on Austrian ski slopes between 2008 and 2018 [1], and more than 19,000 out-of-hospital cardiac arrest cases were reported by the Northern French Alps Emergency Network from 2004 to 2014 [2]. Regardless of the need of respiratory support during the on-site skiing rescue or the need of respiratory control during the evacuation from the cold slope site, a considerable number of patients need to receive artificial airway establishment and Emergency Medicine International management, so as to maintain ventilation and further basic and advanced life support. The harsh natural environments such as low temperature and steep slope will greatly increase the difficulty of artificial airway establishment and management. There has been no research focusing on the establishment of artificial airway during skiing rescue site. is study aims to simulate the real-world scenario, calculating and comparing the operation time of different artificial airways on the cold slope, and to explore the optimal method of establishing artificial airway on the cold slope, sharing our experience, technical notes, and pitfalls we encountered, hoping to help establish a standard operating procedure in advanced airway management on the ski slope
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