Abstract
Background: Recent recommendations made by ILCOR have de-emphasised the role of advanced airway management such as “endotracheal intubation” (ETI) during cardiac arrest in favour of maximising the number of chest compressions performed by rescuers. Maximising time available for compressions is achieved by minimising hands-off time (HOT). This has led to first responders and paramedics performing single rescuer CPR using a bag-valve-mask (BVM) device as opposed to the historical practice of intubating and ventilating via an endotracheal tube. Bag-valve-mask ventilations, especially during single rescuer CPR, are however associated with complications potentially resulting in increased ventilation times. More time spent on ventilations in the single rescuer scenario naturally leads to an increase in HOT and less time being available for compressions. It is postulated that the use of an appropriate supraglottic airway device (SAD) may decrease the time spent on the ventilation component of CPR and result in a decrease in HOT.Objectives: This pilot study evaluated how interruptions to chest compressions or hands-off time (HOT) are affected by the placement of an i-gel® airway vs. simple BVM ventilation during single rescuer CPR.Method: 16 participants performed two, ten-minute single rescuer CPR simulations, firstly using the BVM and later the i-gel® airway for ventilation. Data pertaining to ventilations and HOT in each scenario was statistically analysed and compared.Results: The i-gel® airway demonstrated a superior ease of ventilation compared to BVM alone and resulted in a reduction of time spent on ventilations overall. The i-gel® however took a mean of 29 s, ± 10 s, to secure which contributes considerably to HOT.Conclusion: The use of the i-gel® airway resulted in a considerable decrease in the amount of time spent on ventilations and in more compressions being performed. The overall reduction in HOT was, however, offset by the time it took to secure the device. Further investigation into the use and securing of the i-gel® airway in single rescuer CPR is recommended.
Highlights
This study compared differences in hands-off time (HOT) between single rescuer CPR using a BVM and single rescuer CPR using the igel® airway with reference to a) chest compressions, b) cycles of CPR, and c) time taken to assess and secure the airway and ventilate using an i-gel® supraglottic airway device (SAD)
Recent recommendations made by International Liaison Committee on Resuscitation (ILCOR) have de-emphasised the role of advanced airway management such as “endotracheal intubation” (ETI) during cardiac arrest in favour of maximising the number of chest compressions performed by rescuers
No studies have proven the benefit of a single form of airway management strategy over the other, instead, the literature indicates that airway management strategies in CPR should be adapted to the specific circumstances surrounding the CPR (Hazinski et al, 2010)
Summary
This study compared differences in HOT between single rescuer CPR using a BVM and single rescuer CPR using the igel® airway with reference to a) chest compressions, b) cycles of CPR, and c) time taken to assess and secure the airway and ventilate using an i-gel® SAD. Recent recommendations made by ILCOR have de-emphasised the role of advanced airway management such as “endotracheal intubation” (ETI) during cardiac arrest in favour of maximising the number of chest compressions performed by rescuers. Maximising time available for compressions is achieved by minimising hands-off time (HOT) This has led to first responders and paramedics performing single rescuer CPR using a bag-valve-mask (BVM) device as opposed to the historical practice of intubating and ventilating via an endotracheal tube. Objectives: This pilot study evaluated how interruptions to chest compressions or hands-off time (HOT) are affected by the placement of an i-gel® airway vs simple BVM ventilation during single rescuer CPR. Taking the recent ILCOR recommendations into account, local ALS paramedics are performing single rescuer ventilations during CPR with a BVM apparatus as opposed to the historical practice of ETI which is seen to create an opportunity for significant HOT
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