Medicine

The aim of this study is to investigate whether abdominal compression cardiopulmonary resuscitation (CPR) would result in similar survival rates and neurologic outcome than chest compression CPR in a swine model of cardiac arrest. Forty Landrace/Large White piglets were randomized into 2 groups: group A (n = 20) was resuscitated using chest compression CPR, and group B (n = 20) was resuscitated with abdominal compression CPR. Ventricular fibrillation was induced with a pacemaker catheter, and animals were left untreated for 8 minutes. Abdominal and chest compressions were applied with a mechanical compressor. Defibrillation was then attempted. Neuron-specific enolase and S-100 levels were significantly higher in group B. Ten animals survived for 24 hours in group A in contrast to only 3 animals in group B (P < .05). Neurologic alertness score was worse in group B compared with group A. Abdominal compression CPR does not improve survival and neurologic outcome in this swine model of cardiac arrest and CPR.

The authors report a prospective randomized blind study in which they used a refined anesthetic technique in male Landrace/Large White swine (n = 125 pigs, 19 ± 2 kg, 10-15 weeks old). The animals were first premedicated with ketamine, midazolam and atropine and then given a dose of 1, 2, 3, 4 or 5 μg remifentanil per kg body weight (dose amounts were randomly assigned) after a bolus dose of propofol. The authors assessed the intubation conditions (e.g., jaw relaxation and other parameters) 20 min after premedication and then 5 min after anesthesia induction. All animals that received each of the different remifentanil dose amounts were successfully intubated in less than 30 s. No animal developed apnea during intubation or experienced substantial reductions in heart rate or blood pressure (> 25%) between the two time points (20 min after premedication and 5 min after anesthesia induction). Overall intubation conditions were significantly better in animals that received 5 μg remifentanil per kg body weight than in animals that received other dose amounts (P < 0.001). The average time to intubation was significantly shorter for animals that received 5 μg remifentanil per kg body weight than for animals that received any of the other dose amounts (P < 0.001). The authors concluded that for this study, 5 μg remifentanil per kg body weight resulted in excellent intubating conditions in this swine breed.

Airway management is of utmost importance in critical patients, for whom endotracheal intubation remains the gold standard. However, it is a difficult skill to acquire and success rates in novices are unacceptably low. Supraglottic devices constitute promising alternatives. The aim of this study was to assess the use of laryngeal mask airway (LMA) classic LMA (cLMA) and a relatively new supraglottic device, the i-gel, in experienced and novice doctors in a manikin setting. The study population comprised 116 doctors. After a brief educational session and presentation of cLMA and i-gel, participants were randomly allocated to insert both devices in an adult manikin. Insertions were performed using a size-4 cLMA and a size-4 i-gel. The primary endpoints were the success rate for each device and the duration of the insertion attempt. Secondary endpoint was the perception of ease of use with each device. First attempt success rate was 90.5% for i-gel and 63.8% for cLMA (P<0.001). I-gel use reduced insertion times (13.32±4.99 s vs. 17.99±6.87 s, P<0.001) and was related with significantly higher first attempt success rates than cLMA in novices (90 vs. 48.3%, P<0.001). In addition, i-gel use provided almost equal success rates for experienced and novice doctors (91 vs. 90%, P=not significant), whereas cLMA use resulted in significantly lower success rates for novices (48.3 vs. 80.4%, P<0.001). In this manikin setting i-gel significantly improved success rates and insertion time compared with cLMA. Most importantly, i-gel use resulted in high first pass success rates for novice doctors, equal to those achieved by experienced doctors.