Alternative ways of maintaining the airway in prehospital conditions

BACKGROUND: Quality airway management is essential for the proper treatment of vitally endangered patients. An adequate oxygenation and ventilation are the main emergency procedures. A method of opening and maintaining the airway is rather simple, but effective i.e. it is done in a short time and with minimal equipment. Endotracheal intubation (ETI) is the best procedure, the so-called 'gold standard', but it is not always possible in the prehospital conditions. Every prehospital intubation can be difficult, so there are various alternative methods and devices to be considered. In our Department we have access to some supraglottic devices: a Laryngeal mask, a Combitube (the double-lumen airway), a King laryngeal tube and an I-gel. OBJECTIVE: To show the alternative ways of maintaining the airway in prehospital conditions, according to the prearranged plan in case when the airway problem occurs and to point out all the advantages and disadvantages of the process. METHOD: Retrospective analysis of protocol in SHMP Subotica over the period from 01/01/2013 to 31/12/2013 RESULTS: Out of the total number of resuscitation, which is 83, 78 of them (94%) were realized in the field (i.e. in the patients' home or public places) and 5 (6%) were realized during the transportation of patients with an acute myocardial infarction to ICVDV (The Institute of Cardiovascular Diseases) in Sremska Kamenica. 23 patients (27,7%) were intubated and the remaining 20 patients (33,3%) returned to normal sinus rhythm after the first/ second defibrillation and started to breathe spontaneously, on 21 patients (35%) were used supraglottic devices and 19 patients (31,7%) were provided with medical care with the mask ventilation balloon. The supraglottic device most commonly used was i-gel, among 12 patients (57,14%). CONCLUSION: In cases when the endotracheal intubation was not possible, the i-gel proved to be the best second generation supraglottic airway device among all the other alternative devices. It is designed to be applied quickly and easily and no extensive experience is needed when operating. It allows adequate inflation, but the main drawback is that it does not enable suction.