Article of the Month
Dear colleagues and airway enthusiast
After a short summer holiday season, we are back with the article of month. This month’s contribution came from Prof. Arnd Timmermann. His article of the month is a German study done by the anesthesiologist and A&E physician Michael Bernhard and Coworkers from Leipzig, Germany. He took a closer look to the raising concerns around the usage of supraglottic airway devices (SAD) for out-of-hospital airway management. The dominate SAD device in Germany is the laryngeal tube (LT). The LT was critized for the unrecognized malposition’s leading in massive stomach inflation (≈10%) and severe tongue swelling (≈40%). It is unclear, if the usage of the LT and the specific malposition’s had any influence in the outcome of patients ventilated by the LT. Therefore the authors retrospectively analyzed data from the German Resuscitation Registry for a study period of 6½ years, including approximately 43.000 patients after out of-hospital cardiac arrest treated with manual chest compression and automated chest compression devices and who were ventilated by a laryngeal tube or an endotracheal tube. Nearly 27.500 patients fulfilled study criteria and were including for further analysis. This study demonstrated that patients treated with SAD only suffered from the lowest hospital admission rate with ROSC, lowest survival rate to hospital, discharge, and lowest survival rate to hospital discharge with good neurological outcome in comparison to all other airway and compression methods. The result were better if the LT was immediately was replaced with an ET by a supporting emergency physician at the out of hospital scene. The authors concluded that SAD only should be avoided or SAD should be changed into ETI, independent of whether chest compression method was used.