Semiprone position is superior to supine position for paediatric endotracheal intubation during massive regurgitation, a randomized crossover simulation trial

Espen Fevang,Jo Røislien,Conrad Arnfinn Bjørshol,Karin Haaland

doi:10.1186/s12871-018-0474-z

Abstract

BackgroundEndotracheal intubation of patients with massive regurgitation represents a challenge in emergency airway management. Gastric contents tend to block suction catheters, and few treatment alternatives exist. Based on a technique that was successfully applied in our district, we wanted to examine if endotracheal intubation would be easier and quicker to perform when the patient is turned over to a semiprone position, as compared to the supine position.MethodsIn a randomized crossover simulation trial, a child manikin with on-going regurgitation was intubated both in the supine and semiprone positions. Endpoints were experienced difficulty with the procedure and time to intubation, as well as visually confirmed intubation and first-pass success rate.ResultsIntubation in the semiprone position was significantly easier and faster compared to the supine position; the median experienced difficulty on a visual analogue scale was 27 and 65, respectively (p = 0.004), and the median time to intubation was 26 and 45 s, respectively (p = 0.001). There were no significant differences in frequency of visually confirmed intubation (16 and 18, p = 0.490) of first-pass success rate (17 and 18, p = 1.000).ConclusionIn this experiment, endotracheal intubation during massive regurgitation with the patient in the semiprone position was significantly easier and quicker to perform than in the supine position. Endotracheal intubation in the semiprone position can provide a quick rescue method in situations where airway management is hindered by massive regurgitation, and it represents a possible supplement to current airway management training.

Highlights

Endotracheal intubation of patients with massive regurgitation represents a challenge in emergency airway management
The aim of this study was to examine whether turning the patients over to the semiprone position during Endotracheal intubation (ETI) is superior to a regular ETI in the supine position, as a rescue method when massive regurgitation occurs
The assistant supported the head during the intubation in most cases, while for some the person performing the intubation supported the head with the inside of the hand, while digits one and two were used to insert the tube (Fig. 1)

Summary

Introduction

Endotracheal intubation of patients with massive regurgitation represents a challenge in emergency airway management. Endotracheal intubation (ETI) is a procedure that is frequently performed both inside and outside hospitals [1]. All ventilation and intubation attempts in the supine position were impossible because of massive regurgitation with a mixture of gastric contents, seawater and pulmonary fluids, and the available manual suction unit was instantly blocked by food solids. Identification of the laryngeal opening was facilitated by bursts of pulmonary fluid during chest compressions, and visually confirmed intubation of both patients was uncomplicated in this position. Both children underwent ETI in less than two minutes after water extrication, and there were no interruptions in chest compressions during the procedure. Return of spontaneous circulation occurred in both patients within 20 min after cardiopulmonary resuscitation (CPR) started, and both patients were discharged from the hospital with no known sequelae

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