All About Supraglottic Airway… pt. 2

This week I am highlighting two airway discussion points which have recently come to my attention: cuffed vs. non-cuffed endotracheal tubes (ETTs) in pediatric patients and the possible, negative side effects of supraglottic airways.

See my first post on cuffed vs. non-cuffed endotracheal tubes: Part 1

Supraglottic Airways: Help or Harm?

Health Care Providers (HCPs), working in multi-disciplinary, team oriented environments, are able to achieve rapid and early airway management without interrupting resuscitation efforts. However, the role of ETTs has been de-emphasized during cardiac arrest management and HCPs are encouraged to use alternate airway devices, such as supraglottic airways.

Supraglottic airways minimize interruptions in compressions and as a result, maximal blood flow to the brain. Or, so we thought…

A recent swine study shows evidence supraglottic devices may decrease cerebral blood flow in low output states. See the article below.

http://emcrit.org/wee/extraglottic-airways-harmful-cardiac-arrest/

 Supraglottic Airway

In the ACLS courses I instruct at Iridia, I have been strongly encouraging the use of supraglottic airway devices.  Mainly because King Tubes or laryngeal mask airways can be inserted without stopping chest compressions and this allows for more blood to the brain. But, if these airway devices impede blood flow to the brain, should we be using them at all?

What is the future of airway management during cardiac arrests? Will newer, high-tech devices make it to market or will airway management go back to a head-tilt, chin-lift with oxygen from a simple mask?

I’d love to hear your thoughts and opinions. Let me know what you think about these discussion points.

CPR and First Aid Retention – Revisited

Back in October, we talked about CPR and First Aid Skill Retention. At the time, a WorkSafe BC study showed that many of the skills learned in CPR and First Aid courses were forgotten shortly after certification.

First Aid Retention

The WorkSafe study came to these conclusions:

• Many skills deteriorate rapidly over the course of the first 90 days.
• Repetition (the number of times trained/certified in First Aid or CPR) may be more important to skill retention than the length of time since the last training.
• A number of skills were performed poorly regardless of how much time had passed since the last training.
• Simple and cost effective updating strategies for first aid and CPR are needed to reduce the rate of knowledge and skill deterioration.

Their recommendation was to do a refresher course every 90 days, as individuals who repeated certification tended to score higher on exams. Repetition is the key.

First Aid Retention

Now, fast forward five months and it seems that WorkSafe’s initial findings were spot on. In a review of 11 international studies, researchers have found health providers’ skills in advanced life support typically deteriorated six months to a year after training.

Currently, the standard guidelines call for re-training every two years. These guidelines are quoted as “not optimal” by Dr. Lance Becker, director of the Center for Resuscitation Science at the University of Pennsylvania in Philadelphia.

So why do widespread guidelines recommend re-training every two years?

According to Becker, one of the main reasons was convenience; historically the two-year time frame was seen as an easy fit for busy schedules. Another, he said, is the lack of good research showing a shorter interval is necessary.

Without evidence from well-designed studies, it’s hard to change guidelines, Becker noted.

What’s needed, he said, is more research into the best ways to train and retrain people in advanced life support and first aid retention.

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At Iridia we understand the need to provide high-quality training; we focus our training on positive and interactive instructional methods, combined with practical hands-on components.

Please view our ACLS flyer for more information.

Our medical education and instructors are consistently praised for lowering the stress and pressure that many health care professionals associate with Advanced Cardiac Life Support (ACLS) continuing education.

If you are interested in continuing your medical education please visit us, we provide a wide variety of courses from ACLS to basic CPR and AED training and recertification.