engleski

Differences in airway management during out-of-hospital cardiopulmonary resuscitation (CPR) between experienced and inexperienced emergency medical physicians

Purpose: Airway management is one of the primary considerations during CPR. Although endotracheal intubation (ETI) is the safest method to secure the airway, it requires skill and experience, so introduction of supraglottic devices (SGDs) revolutionized airway management. However, these advanced techniques have complications and are often poorly performed by inexperienced physicians. This study investigates differences in airway management during out-of-hospital CPR between experienced and inexperienced emergency medical physicians. Materials and methods: We analysed Utstein Style Forms (USFs) and medical records of all out-of-hospital CPRs performed between January 1, 2008 and December 31, 2013 by Emergency Medical Service (EMS) Varazdin, Croatia. Experienced physicians were considered those working≥1 year, while inexperienced those working <1 year in a prehospital setting. Results: We analyzed 213 USFs and medical records of outof hospital CPRs: 154 were performed by experienced physicians (no. of physicians = 14), while 59 were performed by inexperienced physicians (no. of physicians = 26). Airway management was dependent on physicians’ experience in a prehospital setting (inexperienced vs. experienced physicians: P = 0.016). Compared with experienced physicians, inexperienced physicians used Guedel airway together with bag-valve-mask ventilation more frequently (inexperienced vs. experienced = 26% vs. 9%, P = 0.003 ; Bonferroni corrected P < 0.017), and less frequently the advanced techniques (inexperienced vs. experienced = 71% vs. 88%, P = 0.004). There was no difference in airway management during out-of- hospital CPRs by placing SGDs (inexperienced vs. experienced physicians = 41% vs. 44%, P = 0.758), and ETI (inexperienced vs. experienced physicians = 31% vs. 46%, P = 0.063). Conclusion: For the past decade the best method of airway management during CPR still stands controversial because of the complications associated with advanced techniques, such as ETI and SGDs. That is probably why inexperienced physicians in EMS Varazdin felt more comfortable using basic airway manoeuvres and adjuncts when performing CPR.

airway management; CPR; resuscitation physicians

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