Conflict of interest 22.03.2021
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22.03.2021
Conflict of interest
1
22.03.2021
GFDL
https://commons.wikimedia.org/wiki/Commons:GNU_Free_Documentation_License
Creative Commons:
https://creativecommons.org/licenses/by-sa/4.0/deed.en
• Anatomie
• Devices
• Atemwegssicherung
2
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3
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Ausfall der Schutzreflexe
Erbrechen
Trauma
4
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Überstrecken
http://de.wikipedia.org/wiki/Bild:Atemwege_frei.JPG
https://de.wikipedia.org/wiki/Datei:Atemwege_zu.JPG
Wendl-Tubus
http://www.pflegewiki.de/wiki/Bild:Wendltubus.jpg
5
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Güdel
https://commons.wikimedia.org/wiki/File:One-piece_Guedel_Airways.jpg
Larynxmaske
https://commons.wikimedia.org/wiki/File:ProSeal_Laryngeal_Mask_Airway_inflated_001.jpg
https://commons.wikimedia.org/wiki/File:LMA_Adult_size_4.JPG
6
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iGel
https://commons.wikimedia.org/wiki/File:Airway.larynxmasker.laryngeal.mask.gelei.JPG
Larynxtubus
https://de.wikipedia.org/wiki/Larynxtubus#/media/Datei:Larynxtubus.jpg
7
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Kombitubus
Endotrachealtubus
https://commons.wikimedia.org/wiki/File:Endotracheal_Tube.JPG
8
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Tracheostoma
https://commons.wikimedia.org/wiki/File:Tracheostomy_tube.jpg
I, Welleschik, CC BY-SA 3.0
http://creativecommons.org/licenses/by-sa/3.0/, via Wikimedia Commons
9
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© T. Tersch
Arulkumaran, N., J. Lowe, R. Ions, M. Mendoza, V. Bennett, und M. W. Dunser. 2018. „Videolaryngoscopy versus Direct
Laryngoscopy for Emergency Orotracheal Intubation Outside the Operating Room: A Systematic Review and Meta- © Stefan Reitzner
Analysis“. British Journal of Anaesthesia 120 (4): 712–24.
1022.03.2021
Kegelförmiger Larynx
Engste Stelle
subglottisch
1122.03.2021
1222.03.2021
No RCTs have shown that
tracheal intubation increases
survival after cardiac arrest.
1322.03.2021
If an advanced airway is required, only
rescuers with a high tracheal intubation
success rate should use tracheal
intubation. The expert consensus is that a
high success rate is over 95% within two
attempts at intubation
Jr, Benger, Kirby K, Black S, Brett Sj, Clout M, Lazaroo Mj, Nolan Jp, u. a. „Effect of a Strategy of
a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on
Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial“. JAMA.28. August 2018
https://cpb-eu-w2.wpmucdn.com/blogs.bristol.ac.uk/dist/1/681/files/2020/07/AIRWAYS-2-
Infographic-FINAL-P1-212x300.jpg
1422.03.2021
ET LT
Survival 8,1% 10,8%
Airway failure 44,1% 11,8%
Wang, Henry E., Robert H. Schmicker, Mohamud R. Daya, Shannon W. Stephens, Ahamed H. Idris, Jestin N. Carlson, M. Riccardo Colella, u. a.
„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“. JAMA 320, Nr. 8 (28. August 2018): 769.
ET BMV
Survival 5,4% 5,3%
Airway difficulty 13,4% 18,1%
Airway failure 2,1% 6,7%
1522.03.2021
LT BMV ET
30 Tage Überleben 8,6% 24,3% 17,1%
30 Tage Überleben 21,3% 56,4% 37,4%
schockbar
Time to ROSC [min] 14 14 11
Sulzgruber, Patrick, Philip Datler, Fritz Sterz, Michael Poppe, Elisabeth Lobmeyr, Markus Keferböck, Sebastian Zeiner, u. a. „The Impact of Airway
Strategy on the Patient Outcome after Out-of-Hospital Cardiac Arrest: A Propensity Score Matched Analysis“. European Heart Journal. Acute
Cardiovascular Care 7, Nr. 5 (August 2018): 423–31.
Beutel-Maske
SGA:
Schnellere Beatmung
Höhere Tidalvolumina
Sg, Russo, Bollinger M, Strack M, Crozier Ta, Bauer M, und Heuer Jf. „Transfer of Airway Skills
from Manikin Training to Patient: Success of Ventilation with Facemask or LMA-Supreme(TM) by
Medical Students“. Anaesthesia. November 2013.
A, Timmermann, Russo Sg, Crozier Ta, Eich C, Mundt B, Albrecht B, und Graf Bm. „Novices
Ventilate and Intubate Quicker and Safer via Intubating Laryngeal Mask than by Conventional
Bag-Mask Ventilation and Laryngoscopy“. Anesthesiology, Oktober 2007.
1622.03.2021
Wer spielt denn mit?
SanitäterIn NotärztIn PatientIn
1722.03.2021
Lernkurve
% Success
90
80
70
60
50
40
30
20
10
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93 95 97 99
% Success
BMV LMA
Puppe 100% 100%
Mensch 66% 90%
Sg, Russo, Bollinger M, Strack M, Crozier Ta, Bauer M, und Heuer Jf. „Transfer of Airway Skills from Manikin Training to
Patient: Success of Ventilation with Facemask or LMA-Supreme(TM) by Medical Students“. Anaesthesia. November 2013.
1822.03.2021
Intubation
Im elektiven Setting min. 50 ETIs für
>90% Erfolg mit 2 Versuchen
(…) mindestens 100 Intubationen zum
Erlernen der Technik unter Aufsicht (…)
nachfolgend mindestens 10 ETI pro Jahr (…)
A.Timmermann, B.W.Böttiger, C.Byhahn, et. Al, AWMF S1 Leitlinie „Prähospitales Atemwegsmanagement, 2019
Larynxtubus
Klaver, N. S., K. Kuizenga, A. Ballast, und V. Fidler. „A Comparison of the Clinical Use of the Laryngeal Tube S and the ProSeal
Laryngeal Mask Airway by First-Month Anaesthesia Residents in Anaesthetised Patients“. Anaesthesia 62, Nr. 7 (Juli 2007): 723–27.
1922.03.2021
Beutel-Maske
Komatsu, Ryu, Yusuke Kasuya, Hisanori Yogo, Daniel I. Sessler, Edward Mascha, Dongsheng Yang, und Makoto Ozaki. „Learning Curves for Bag-and-Mask
Ventilation and Orotracheal IntubationAn Application of the Cumulative Sum Method“. Anesthesiology 112, Nr. 6 (1. Juni 2010): 1525–31
Larynxmaske
S, Mohr, Weigand Ma, Hofer S, Martin E, Gries A, Walther A, und Bernhard
M. „Developing the Skill of Laryngeal Mask Insertion: Prospective Single
Center Study“. Der Anaesthesist, Juni 2013.
T, Nakanishi, Sakamoto S, Yoshimura M, und Toriumi T. „A Learning Curve of LMA ®
ProSealTM Insertion: A Prospective Analysis of Cumulative Sum Method“. Journal of
anesthesia. J Anesth, August 2020.
2022.03.2021
J, Duckett, Fell P, Han K, Kimber C, und Taylor C. „Introduction of the I-Gel Supraglottic Airway Device for Prehospital Airway
Management in a UK Ambulance Service“. Emerg Med J, Juni 2014.
D, Häske, Gaier G, Heinemann N, Schempf B, und Renz Ju. „Minimal Training for First Responders with the I-GelTM Leads to Successful
Use in Prehospital Cardiopulmonary Resuscitation“. Resuscitation, Januar 2019
Rechnen wir…
Rotes Kreuz: ~45.000
Samariterbund: ~3.000 BMV - 25 Pat.: 175 000
MA 70: ~700 LMA – 30 Pat: 210 000
Johanniter: ~710 ITN – 100 Pat: 700 000
Summe: ca. 50.000
25 Jahre Dienst
2000/ Jahr
1 279 080
7000/Jahr
Operationen/Jahr
https://www.statistik.at/web_de/statistiken/menschen_und_gesellschaft/gesundheit/stationaere_aufenthalte/medizinische_leistungen/022015.html
Auskunft der HiOrgs.
2122.03.2021
We suggest using bag-mask
ventilation or an advanced airway
strategy during CPR for adult
cardiac arrest in any setting (weak
recommendation, low to moderate
certainty of evidence).
2222.03.2021
If an advanced airway is used, we
suggest a SGA for adults with
OHCA in settings with a low TI
success rate (weak
recommendation, low certainty of
evidence).
If an advanced airway is used, we
suggest an SGA or TI for adults with
OHCA in settings with a high TI
success rate (weak
recommendation, very low certainty
of evidence).
2322.03.2021
Kjærgaard, et al. 2016. „Four ways to ventilate during cardiopulmonary resuscitation
in a porcine model: a randomized study“. Scandinavian Journal of Trauma, commons.wikimedia.org
Resuscitation and Emergency Medicine 24 (Mai).
2422.03.2021
2522.03.2021 MACOCHA Mallampati III oder IV 5 Obstructive Sleep Apnoea Syndrome 2 Reduced Mobility of the Cervical Spine 1 Limited Mouth Opening
22.03.2021
Thispersondoesnotexist.com
Atemwegsbeurteilung
• Mallampati
• Upper Lip Bite Test
Jmarchn, CC BY-SA 3.0, via Wikimedia Commons
2722.03.2021
Suction
Oxygen
Airway
Positioning
Meds
Equipment/etCO2
vintagelove67, CC BY-SA 2.0 https://creativecommons.org/licenses/by-sa/2.0, via Wikimedia Commons
2822.03.2021
© T. Tersch
2922.03.2021
SALAD
© Simon Althaus, James DuCanto
3022.03.2021
Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults
C. Frerk, V. S. Mitchell, A. F. McNarry, C. Mendonca, R. Bhagrath, A. Patel, E. P. O’Sullivan, N. M. Woodall and I. Ahmad, Difficult Airway Society
intubation guidelines working group, British Journal of Anaesthesia, 115 (6): 827–848 (2015) doi:10.1093/bja/aev371
Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults
C. Frerk, V. S. Mitchell, A. F. McNarry, C. Mendonca, R. Bhagrath, A. Patel, E. P. O’Sullivan, N. M. Woodall and I. Ahmad, Difficult Airway Society
intubation guidelines working group, British Journal of Anaesthesia, 115 (6): 827–848 (2015) doi:10.1093/bja/aev371
3122.03.2021
When novices attempted to intubate the trachea in microgravity, the
success rate of tracheal intubation using a videolaryngoscope was
significantly higher(…), and intubation time was shorter, compared with
using a direct laryngoscope.
3222.03.2021
© D. Bomze
© A. Maleczek
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