nach oben

Notfall + Rettungsmedizin

10.06.2016 | Übersicht

First-Pass Intubation Success

Bedeutung und Umsetzung in der Notfallmedizin

verfasst von: Priv.-Doz. Dr. med J. Knapp, V. Wenzel, R. Greif, B. Hossfeld, M. Bernhard

Erschienen in: Notfall + Rettungsmedizin

Einloggen, um Zugang zu erhalten

Zusammenfassung

Hintergrund

Das Atemwegsmanagement ist eine der zentralen Aufgaben eines jeden notfallmedizinisch tätigen Arztes. Die prähospitale endotracheale Intubation stellt sich dabei im Vergleich zur innerklinischen Situation oft als schwieriger und komplikationsreicher dar.

Methode

Anhand der vorliegenden Literatur soll die Bedeutung einer erfolgreichen endotrachealen Intubation im ersten Versuch (sog. First-Pass Intubation Success, FPS) und der Möglichkeiten dessen Optimierung in der Notfallmedizin dargestellt und diskutiert werden.

Ergebnisse

Zahlreiche Studien zeigen, dass bei 2 oder mehr Intubationsversuchen die Rate an Komplikationen (wie z. B. Hypoxie, Aspiration, Herzkreislaufstillstand) um den Faktor 4 bis 7 ansteigt. Die vorliegende Literatur macht deutlich, dass eine wesentliche Voraussetzung für einen möglichst hohen FPS und damit eine hohe Patientensicherheit insbesondere eine gute Ausbildung und regelmäßiges Training in der endotrachealen Intubation ist. Eine Narkoseeinleitung sollte standardisiert und nach sorgsamer Präoxygenierung erfolgen. Die Bedeutung des Einsatzes von Muskelrelaxanzien und der Videolaryngoskopie für den FPS steht zur Diskussion.

Davis DP, Peay J, Sise MJ, Kennedy F, Simon F, Tominaga G et al (2010) Prehospital airway and ventilation management: a trauma score and injury severity score-based analysis. J Trauma 69:294–301CrossRefPubMed

Mayglothling J, Duane TM, Gibbs M, McCunn M, Legome E, Eastman AL et al (2012) Emergency tracheal intubation immediately following traumatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 73:333–340CrossRef

Cook TM, Woodall N, Frerk C, Fourth National Audit P (2011) Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 106:617–631CrossRefPubMed

Cook TM, Woodall N, Harper J, Benger J, Fourth National Audit P (2011) Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth 106:632–642CrossRefPubMed

Lossius HM, Roislien J, Lockey DJ (2012) Patient safety in pre-hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers. Crit Care 16:R24CrossRefPubMedPubMedCentral

Kheterpal S, Martin L, Shanks AM, Tremper KK (2009) Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Anesthesiology 110:891–897CrossRefPubMed

Timmermann A, Russo SG, Eich C, Roessler M, Braun U, Rosenblatt WH et al (2007) The out-of-hospital esophageal and endobronchial intubations performed by emergency physicians. Anesth Analg 104:619–623CrossRefPubMed

Bernhard M, Beres W, Timmermann A, Stepan R, Greim CA, Kaisers UX et al (2014) Prehospital airway management using the laryngeal tube. An emergency department point of view. Anaesthesist 63:589–596CrossRefPubMed

Herff H, Wenzel V, Dorges V (2008) Avoiding field airway management problems. Resuscitation 77:4–5CrossRefPubMed

10.

Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG et al (2013) Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 118:251–270CrossRefPubMed

11.

Combes X, Jabre P, Margenet A, Merle JC, Leroux B, Dru M et al (2011) Unanticipated difficult airway management in the prehospital emergency setting: prospective validation of an algorithm. Anesthesiology 114:105–110CrossRefPubMed

12.

Xue FS, Liao X, Yuan YJ, Wang Q, Liu JH (2011) Management of unanticipated difficult airway in the prehospital emergency setting. Anesthesiology 115:441–442CrossRefPubMed

13.

Yan Z, Tanner JW, Lin D, Chalian AA, Savino JS, Fleisher LA et al (2013) Airway trauma in a high patient volume academic cardiac electrophysiology laboratory center. Anesth Analg 116:112–117CrossRefPubMed

14.

Bernhard M, Becker TK, Gries A, Knapp J, Wenzel V (2015) The first shot is often the best shot: first-pass Intubation success in emergency airway management. Anesth Analg 121:1389–1393CrossRefPubMed

15.

Helm M, Kremers G, Lampl L, Hossfeld B (2013) Incidence of transient hypoxia during pre-hospital rapid sequence intubation by anaesthesiologists. Acta Anaesthesiol Scand 57:199–205CrossRefPubMed

16.

Nakstad AR, Heimdal HJ, Strand T, Sandberg M (2011) Incidence of desaturation during prehospital rapid sequence intubation in a physician-based helicopter emergency service. Am J Emerg Med 29:639–644CrossRefPubMed

17.

Newton A, Ratchford A, Khan I (2008) Incidence of adverse events during prehospital rapid sequence intubation: a review of one year on the London Helicopter Emergency Medical Service. J Trauma 64:487–492CrossRefPubMed

18.

Bernhard M, Matthes G, Kanz KG, Waydhas C, Fischbacher M, Fischer M et al (2011) Emergency anesthesia, airway management and ventilation in major trauma. Background and key messages of the interdisciplinary S3 guidelines for major trauma patients. Anaesthesist 60:1027–1040CrossRefPubMed

19.

Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A et al (2015) Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adultsdagger. Br J Anaesth 115:827–848CrossRefPubMedPubMedCentral

20.

Sakles JC, Chiu S, Mosier J, Walker C, Stolz U (2013) The importance of first pass success when performing orotracheal intubation in the emergency department. Academic emergency medicine : official journal of the Society for. Acad Emerg Med 20:71–78CrossRefPubMedPubMedCentral

21.

Martin LD, Mhyre JM, Shanks AM, Tremper KK, Kheterpal S (2011) 3,423 emergency tracheal intubations at a university hospital: airway outcomes and complications. Anesthesiology 114:42–48CrossRefPubMed

22.

Hasegawa K, Hagiwara Y, Imamura T, Chiba T, Watase H, Brown CA 3rd et al (2013) Increased incidence of hypotension in elderly patients who underwent emergency airway management: an analysis of a multi-centre prospective observational study. Int J Emerg Med 6:12CrossRefPubMedPubMedCentral

23.

Hasegawa K, Shigemitsu K, Hagiwara Y, Chiba T, Watase H, Brown CA 3rd et al (2012) Association between repeated intubation attempts and adverse events in emergency departments: an analysis of a multicenter prospective observational study. Ann Emerg Med 60:749–754.e2CrossRefPubMed

24.

Mort TC (2004) Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg 99:607–613CrossRefPubMed

25.

Rognas L, Hansen TM, Kirkegaard H, Tonnesen E (2013) Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Scand J Trauma Resusc Emerg Med 21:58CrossRefPubMedPubMedCentral

26.

Kim J, Kim K, Kim T, Rhee JE, Jo YH, Lee JH et al (2014) The clinical significance of a failed initial intubation attempt during emergency department resuscitation of out-of-hospital cardiac arrest patients. Resuscitation 85:623–627CrossRefPubMed

27.

Duggan LV, Minhas KS, Griesdale DE et al (2014) Complications increase with greater than one endotracheal intubation attempt: experience in a Canadian adult tertiary-care teaching center. J Clin Anesth 26:167CrossRef

28.

Goto T, Gibo K, Hagiwara Y, Morita H, Brown DF, Brown CA 3rd et al (2015) Multiple failed intubation attempts are associated with decreased success rates on the first rescue intubation in the emergency department: a retrospective analysis of multicentre observational data. Scand J Trauma Resusc Emerg Med 23:5CrossRefPubMedPubMedCentral

29.

Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW (2005) Management of the difficult airway: a closed claims analysis. Anesthesiology 103:33–39CrossRefPubMed

30.

Harris T, Lockey D (2011) Success in physician prehospital rapid sequence intubation: what is the effect of base speciality and length of anaesthetic training? Emerg Med J 28:225–229CrossRefPubMed

31.

Warner KJ, Carlbom D, Cooke CR, Bulger EM, Copass MK, Sharar SR (2010) Paramedic training for proficient prehospital endotracheal intubation. Prehosp Emerg Care 14:103–108CrossRefPubMed

32.

Bernhard M, Mohr S, Weigand MA, Martin E, Walther A (2012) Developing the skill of endotracheal intubation: implication for emergency medicine. Acta Anaesthesiol Scand 56:164–171CrossRefPubMed

33.

Schupfer GK, Konrad C, Poelaert JI (2003) Manual skills in anaesthesiology. Anaesthesist 52:527–534PubMed

34.

Grissom TE, Sappenfield J, Galvagno SM Jr., Cherry SV, Chang Y‑CC, Hu PF (2014) Performance assessment in airway management training for nonanesthesiology trainees: an analysis of 4,282 airway procedures performed at a level-1 trauma center. Anesthesiology 120:185–195CrossRefPubMed

35.

Hirsch-Allen AJ, Ayas N, Mountain S, Dodek P, Peets A, Griesdale DE (2010) Influence of residency training on multiple attempts at endotracheal intubation. Can J Anaesth 57:823–829CrossRefPubMed

36.

Vassiliadis J, Tzannes A, Hitos K, Brimble J, Fogg T (2015) Comparison of the C‑MAC video laryngoscope with direct Macintosh laryngoscopy in the emergency department. Emerg Med Australas 27:119–125CrossRefPubMed

37.

Oliveira FGR de (2002) The construction of learning curves for basic skills in anesthetic procedures: an application for the cumulative sum method. Anesth Analg 95:411–416

38.

Komatsu R, Kasuya Y, Yogo H, Sessler DI, Mascha E, Yang D et al (2010) Learning curves for bag-and-mask ventilation and orotracheal intubation: an application of the cumulative sum method. Anesthesiology 112:1525–1531CrossRefPubMed

39.

Vennila R, Sethuraman D, Charters P (2012) Evaluating learning curves for intubation in a simulator setting: a prospective observational cumulative sum analysis. Eur J Anaesthesiol 29:544–545CrossRefPubMed

40.

Rujirojindakul P, McNeil E, Rueangchira-Urai R, Siripunt N (2014) Learning curves of macintosh laryngoscope in nurse anesthetist trainees using cumulative sum method. Anesthesiol Res Pract 2014:850731PubMedPubMedCentral

41.

Buis ML, Maissan IM, Hoeks SE, Klimek M, Stolker RJ (2016) Defining the learning curve for endotracheal intubation using direct laryngoscopy: A systematic review. Resuscitation 99:63–71CrossRefPubMed

42.

Timmermann A, Byhahn C, Wenzel V, Eich C, Piepho T, Bernhard M et al (2012) Handlungsempfehlung für das präklinische Atemwegsmanagement. Anästh Intensivmed 53:294–308

43.

Soar J, Nolan JP, Bottiger BW, Perkins GD, Lott C, Carli P et al (2015) European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 95:100–147CrossRefPubMed

44.

Gries A, Zink W, Bernhard M, Messelken M, Schlechtriemen T (2006) Realistic assessment of the physician-staffed emergency services in Germany. Anaesthesist 55:1080–1086CrossRefPubMed

45.

Prause G, Wildner G, Kainz J, Bossner T, Gemes G, Dacar D et al (2007) Strategies for quality assessment of emergency helicopter rescue systems. The Graz model. Anaesthesist 56:461–465CrossRefPubMed

46.

Deakin CD, Murphy D, Couzins M, Mason S (2010) Does an advanced life support course give non-anaesthetists adequate skills to manage an airway? Resuscitation 81:539–543CrossRefPubMed

47.

Herff H, Wenzel V, Lockey D (2009) Prehospital intubation: the right tools in the right hands at the right time. Anesth Analg 109:303–305CrossRefPubMed

48.

Khandelwal N, Khorsand S, Mitchell SH, Joffe AM (2016) Head-elevated patient positioning decreases complications of emergent tracheal Intubation in the ward and intensive care unit. Anesth Analg 122:1101-7CrossRefPubMed

49.

Combes X, Jabre P, Jbeili C, Leroux B, Bastuji-Garin S, Margenet A et al (2006) Prehospital standardization of medical airway management: incidence and risk factors of difficult airway. Acad Emerg Med 13:828–834CrossRefPubMed

50.

Bernhard M, Hossfeld B, Bein B, Böttiger B, Bohn A, Fischer M et al (2015) Handlungsempfehlung: Prähospitale Notfallnarkos beim Erwachsenen. Anästh Intensivmed 56:317–335

51.

Lyon RM, Perkins ZB, Chatterjee D, Lockey DJ, Russell MQ, Kent S et al (2015) Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia. Crit Care 19:134CrossRefPubMedPubMedCentral

52.

Lockey DJ, Crewdson K, Lossius HM (2014) Pre-hospital anaesthesia: the same but different. Br J Anaesth 113:211–219CrossRefPubMed

53.

Sherren PB, Tricklebank S, Glover G (2014) Development of a standard operating procedure and checklist for rapid sequence induction in the critically ill. Scand J Trauma Resusc Emerg Med 22:41CrossRefPubMedPubMedCentral

54.

Schmidt CE, Hardt F, Moller J, Malchow B, Schmidt K, Bauer M (2010) Improvement of team competence in the operating room : Training programs from aviation. Anaesthesist 59(717–22):24–26

55.

Mosier JM, Joshi R, Hypes C, Pacheco G, Valenzuela T, Sakles JC (2015) The physiologically difficult airway. West J Emerg Med 16:1109–1117CrossRefPubMedPubMedCentral

56.

Waydhas C, German Society of Trauma Surgery (2012) Preclinical management of multiples injuries: S3 guideline. Unfallchirurg 115:8–13CrossRefPubMed

57.

Heller ML, Watson TR Jr (1962) The role of preliminary oxygenation prior to induction with high nitrous oxide mixtures: polarographic PaO2 study. Anesthesiology 23:219–230CrossRefPubMed

58.

Weingart SD, Levitan RM (2012) Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med 59:165–75.e1CrossRefPubMed

59.

Bouroche G, Bourgain JL (2015) Preoxygenation and general anesthesia: a review. Minerva Anestesiol 81:910–920PubMed

60.

Hanouz JL, Lammens S, Tasle M, Lesage A, Gerard JL, Plaud B (2015) Preoxygenation by spontaneous breathing or noninvasive positive pressure ventilation with and without positive end-expiratory pressure: A randomised controlled trial. Eur J Anaesthesiol 32:881–887PubMed

61.

Perbet S, De Jong A, Delmas J, Futier E, Pereira B, Jaber S et al (2015) Incidence of and risk factors for severe cardiovascular collapse after endotracheal intubation in the ICU: a multicenter observational study. Crit Care 19:257CrossRefPubMedPubMedCentral

62.

Wilcox SR, Bittner EA, Elmer J, Seigel TA, Nguyen NT, Dhillon A et al (2012) Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related complications. Crit Care Med 40:1808–1813CrossRefPubMed

63.

Li J, Murphy-Lavoie H, Bugas C, Martinez J, Preston C (1999) Complications of emergency intubation with and without paralysis. Am J Emerg Med 17:141–143CrossRefPubMed

64.

Ma OJ, Atchley RB, Hatley T, Green M, Young J, Brady W (1998) Intubation success rates improve for an air medical program after implementing the use of neuromuscular blocking agents. Am J Emerg Med 16:125–127CrossRefPubMed

65.

Bozeman WP, Kleiner DM, Huggett V (2006) A comparison of rapid-sequence intubation and etomidate-only intubation in the prehospital air medical setting. Prehosp Emerg Care 10:8–13CrossRefPubMed

66.

Kheterpal S, Healy D, Aziz MF, Shanks AM, Freundlich RE, Linton F et al (2013) Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group. Anesthesiology 119:1360–1369CrossRefPubMed

67.

Rognas L, Hansen TM, Kirkegaard H, Tonnesen E (2014) Anaesthesiologist-provided prehospital airway management in patients with traumatic brain injury: an observational study. Eur J Emerg Med 21:418–423CrossRefPubMedPubMedCentral

68.

Benumof JL, Dagg R, Benumof R (1997) Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1 mg/kg intravenous succinylcholine. Anesthesiology 87:979–982CrossRefPubMed

69.

Sorensen MK, Bretlau C, Gatke MR, Sorensen AM, Rasmussen LS (2012) Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized trial. Br J Anaesth 108:682–689CrossRefPubMed

70.

Sakles JC, Patanwala AE, Mosier JM, Dicken JM (2014) Comparison of video laryngoscopy to direct laryngoscopy for intubation of patients with difficult airway characteristics in the emergency department. Intern Emerg Med 9:93–98CrossRefPubMed

71.

Ibinson JW, Ezaru CS, Cormican DS, Mangione MP (2014) GlideScope Use improves intubation success rates: an observational study using propensity score matching. BioMed Cent Anesthesiol 14:101CrossRef

72.

Hossfeld B, Frey K, Doerges V, Lampl L, Helm M (2015) Improvement in glottic visualisation by using the C‑MAC PM video laryngoscope as a first-line device for out-of-hospital emergency tracheal intubation: An observational study. Eur J Anaesthesiol 32:425–431CrossRefPubMed

73.

Cormack RS, Lehane J (1984) Difficult tracheal intubation in obstetrics. Anaesthesia 39:1105–1111CrossRefPubMed

74.

Boehringer B, Choate M, Hurwitz S, Tilney PV, Judge T (2015) Impact of video laryngoscopy on advanced airway management by critical care transport paramedics and nurses using the CMAC pocket monitor. Biomed Res Int 2015:821302CrossRefPubMedPubMedCentral

75.

Michailidou M, O’Keeffe T, Mosier JM, Friese RS, Joseph B, Rhee P et al (2015) A comparison of video laryngoscopy to direct laryngoscopy for the emergency intubation of trauma patients. World J Surg 39:782–788CrossRefPubMed

Titel: First-Pass Intubation Success
Bedeutung und Umsetzung in der Notfallmedizin
verfasst von: Priv.-Doz. Dr. med J. Knapp
V. Wenzel
R. Greif
B. Hossfeld
M. Bernhard
Publikationsdatum: 10.06.2016
Verlag: Springer Medizin
Erschienen in: Notfall + Rettungsmedizin
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI: https://doi.org/10.1007/s10049-016-0168-3

Springerpflege

Zusammenfassung

Hintergrund

Methode

Ergebnisse

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten