https://genoplivning.dk/wp-content/uploads/2013/07/european-resuscitation-council-guidelines-for-resuscitation-2010-section-4-adult-advanced-life-support.pdf

European Resuscitation Council Guidelines for Resuscitation 2010 Section 4 Adult advanced life support

https://nrr.org/wp-content/uploads/pdf/guidelines/ERC_guidelines/04_ERC_Guidelines_2005_Section4.pdf

European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support.

/pdf/european-resuscitation-council-erc-guidelines-for-1vuo3ljag0.pdf

European Resuscitation Council (ERC) Guidelines for Resuscitation 2005

Importance Emergency medical services (EMS) commonly perform endotracheal intubation (ETI) or insertion of supraglottic airways, such as the laryngeal tube (LT), on patients with out-of-hospital cardiac arrest (OHCA). The optimal method for OHCA advanced airway management is unknown. Objective To compare the effectiveness of a strategy of initial LT insertion vs initial ETI in adults with OHCA. Design, Setting, and Participants Multicenter pragmatic cluster-crossover clinical trial involving EMS agencies from the Resuscitation Outcomes Consortium. The trial included 3004 adults with OHCA and anticipated need for advanced airway management who were enrolled from December 1, 2015, to November 4, 2017. The final date of follow-up was November 10, 2017. Interventions Twenty-seven EMS agencies were randomized in 13 clusters to initial airway management strategy with LT (n = 1505 patients) or ETI (n = 1499 patients), with crossover to the alternate strategy at 3- to 5-month intervals. Main Outcomes and Measures The primary outcome was 72-hour survival. Secondary outcomes included return of spontaneous circulation, survival to hospital discharge, favorable neurological status at hospital discharge (Modified Rankin Scale score ≤3), and key adverse events. Results Among 3004 enrolled patients (median [interquartile range] age, 64 [53-76] years, 1829 [60.9%] men), 3000 were included in the primary analysis. Rates of initial airway success were 90.3% with LT and 51.6% with ETI. Seventy-two hour survival was 18.3% in the LT group vs 15.4% in the ETI group (adjusted difference, 2.9% [95% CI, 0.2%-5.6%]; P  = .04). Secondary outcomes in the LT group vs ETI group were return of spontaneous circulation (27.9% vs 24.3%; adjusted difference, 3.6% [95% CI, 0.3%-6.8%]; P  = .03); hospital survival (10.8% vs 8.1%; adjusted difference, 2.7% [95% CI, 0.6%-4.8%]; P  = .01); and favorable neurological status at discharge (7.1% vs 5.0%; adjusted difference, 2.1% [95% CI, 0.3%-3.8%]; P  = .02). There were no significant differences in oropharyngeal or hypopharyngeal injury (0.2% vs 0.3%), airway swelling (1.1% vs 1.0%), or pneumonia or pneumonitis (26.1% vs 22.3%). Conclusions and Relevance Among adults with OHCA, a strategy of initial LT insertion was associated with significantly greater 72-hour survival compared with a strategy of initial ETI. These findings suggest that LT insertion may be considered as an initial airway management strategy in patients with OHCA, but limitations of the pragmatic design, practice setting, and ETI performance characteristics suggest that further research is warranted. Trial Registration ClinicalTrials.gov Identifier:NCT02419573

/pdf/effect-of-a-strategy-of-initial-laryngeal-tube-insertion-vs-3oluuln6kn.pdf

Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial.

Purpose
To analyze and summarize the published literature relating to the ProSeal LMA (PLMA): a modification of the ‘classic LMA’ (cLMA) with an esophageal drain tube (DT), designed to improve controlled ventilation, airway protection and diagnosis of misplacement.

/pdf/the-proseal-laryngeal-mask-airway-a-review-of-the-literature-3vatxq2ghc.pdf

The ProSeal laryngeal mask airway: a review of the literature.

687±92 2 Dewey RC, Pieper HP, Hunt WE. Experimental cerebral hemodynamics. Vasomotor tone, critical closing pressure, and vascular bed resistance. J Neurosurg 1974; 41: 597±606 3 Aaslid R, Lundar T, Lindegaard K-F, Nornes H. Estimation of cerebral perfusion pressure from arterial blood pressure and transcranial Doppler recordings. In: Miller JD, Teasdale GM, Rowan JO, Galbraith SL, Mendelow AD, eds. Intracranial Pressure VI. Berlin: Springer, 1986; 226±9 4 Belfort MA, Saade GR, Yared M, et al. Change in estimated cerebral perfusion pressure after treatment with nimodipine or magnesium sulfate in patients with preeclampsia. Am J Obstet Gynecol 1999; 181: 402±7 5 Czosnyka M, Matta BF, Smielewski P, Kirkpatrick P, Pickard JD. Cerebral perfusion pressure in head-injured patients: a non-invasive assessment using transcranial Doppler ultrasonography. J Neurosurg 1998; 88: 802±8 6 Czosnyka M, Smielewski P, Piechnik S, Steiner LA, Pickard JD. Cerebral autoregulation following head injury. J Neurosurg 2001; 95: 756±63 7 Athanassiou L, Hancock SM, Mahajan RP. In vitro estimation of cerebral critical closing pressure during simulation of intracranial hypertension. Br J Anaesth 2002; 88: 317P 8 Stacey M, Moppett I, Athanassiou L, Mahajan RP. The effect of systemic compliance on the non-invasive assessment of zero ̄ow pressure in a bench model of pulsatile ̄ow. Br J Anaesth 2002; 89: 196P 9 Hancock SM, Mahajan RP, Athanassiou L. Non-invasive assessment of cerebral perfusion pressure and zerōow pressure in healthy volunteers: effects of changes in carbon dioxide. Br J Anaesth 2001; 87: 175P 10 Hancock SM, Mahajan RP, Athanassiou L. Non-invasive assessment of cerebral perfusion pressure and zerōow pressure in healthy volunteers: effects of changes in end-tidal carbon dioxide. Anesth Analg (in press) 11 Weyland A, Buhre W, Grund S, et al. Cerebrovascular tone rather than intracranial pressure determines the effective downstream pressure of cerebral circulation in the absence of intracranial hypertension. J Neurosurg Anesthesiol 2000; 12: 210±16

Use of the laryngeal tube as a dedicated airway during tracheal intubation.

Background The Laryngeal Tube (LT®) performs similarly to the classic laryngeal mask airway during controlled ventilation but with an improved airway seal. We compared the laryngeal tube with the ProSeal™ laryngeal mask airway (PLMA) throughout anaesthesia. Methods Thirty-two patients were studied using a randomized cross-over design. The primary outcome measure was airway seal pressure. Secondary outcome measures included peak and plateau airway pressures, time to achieve an airway, ease of insertion, airway manipulations required to achieve a patent airway and grade of fibre-optic laryngoscopy. The proportion of patients in whom good, fair or failed ventilation was achieved was also calculated. Results No significant difference was found in regard to seal pressure (PLMA, median 26.5 cm H2O, range 10–40; LT, median 24, range 6–40; P=0.7, 95% confidence interval of the difference 3.5 to –4.0). There were two failures of insertion or ventilation in the LT group and none in the PLMA group. The peak airway pressure with the PLMA was lower than with the LT but the difference was clinically unimportant (PLMA, mean 16.2 cm H2O, sd 3.52; LT, mean 17.9, sd 5.21; P=0.02, 95% confidence interval of the difference –3.1 to –0.28). The PLMA took significantly less time to insert than the LT (PLMA, median 18.5 s, interquartile range 14–26; LT, median 22, interquartile range 15–36.5; P Conclusion The two devices performed equally well in terms of seal pressure. The PLMA was quicker to insert. Efficacy of ventilation was significantly better with the PLMA than the LT. The PLMA allowed a significantly better view of the larynx with a fibre-optic laryngoscope, and may therefore be of more use in cases where visualization of the larynx is required.

Randomized crossover comparison of the ProSealTM laryngeal mask airway with the Laryngeal Tube® during anaesthesia with controlled ventilation

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Use of the laryngeal tube as a dedicated airway during tracheal intubation.

Randomized crossover comparison of the ProSealTM laryngeal mask airway with the Laryngeal Tube® during anaesthesia with controlled ventilation