Evidence map›Paper›PMID 37189061›Full record

Trial reportBMC emergency medicine2023

Impact of COVID-19-adapted guidelines using different airway management strategies on resuscitation quality in out-of-hospital-cardiac-arrest - a randomised manikin study.

Sean S Scholz, Sissy Linder, Eugen Latka, Tobias Bartnick, Daniel Karla, Daniel Thaemel, Marlena Wolff, Odile Sauzet, Sebastian W Rehberg, Karl-Christian Thies and 1 more

Open access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC emergency medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
1.0field-weighted citation impact, top 25% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 3 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 1 country.

Sean S ScholzDepartment of Anaesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, University Hospital OWL, Protestant Hospital of the Bethel Foundation, University of Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany.
Sissy LinderSkillslab, Medical School East Westphalia-Lippe, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany.
Eugen LatkaDepartment of Medical and Emergency Services, Study Institute Westfalen-Lippe, Remterweg 44, D-33617, Bielefeld, Germany.
Tobias BartnickDepartment of Medical and Emergency Services, Study Institute Westfalen-Lippe, Remterweg 44, D-33617, Bielefeld, Germany.
Daniel KarlaDepartment of Medical and Emergency Services, Study Institute Westfalen-Lippe, Remterweg 44, D-33617, Bielefeld, Germany.
Daniel ThaemelDepartment of Medical and Emergency Services, Study Institute Westfalen-Lippe, Remterweg 44, D-33617, Bielefeld, Germany.
Marlena WolffDepartment of Medical and Emergency Services, Study Institute Westfalen-Lippe, Remterweg 44, D-33617, Bielefeld, Germany.
Odile SauzetEpidemiology and International Public Health, Bielefeld School of Public Health & Center for Statistics, Bielefeld University, Bielefeld, Germany.
Sebastian W RehbergDepartment of Anaesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, University Hospital OWL, Protestant Hospital of the Bethel Foundation, University of Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany.
Karl-Christian ThiesDepartment of Anaesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, University Hospital OWL, Protestant Hospital of the Bethel Foundation, University of Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany.
Gerrit JansenDepartment of Medical and Emergency Services, Study Institute Westfalen-Lippe, Remterweg 44, D-33617, Bielefeld, Germany. gerritjansen@freenet.de.
Landschaftsverband Westfalen-Lippe · DEBielefeld University · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough airway management for paramedics has moved away from endotracheal intubation towards extraglottic airway devices in recent years, in the context of COVID-19, endotracheal intubation has seen a revival. Endotracheal intubation has been recommended again under the assumption that it provides better protection against aerosol liberation and infection risk for care providers than extraglottic airway devices accepting an increase in no-flow time and possibly worsen patient outcomes.

methodsIn this manikin study paramedics performed advanced cardiac life support with non-shockable (Non-VF) and shockable rhythms (VF) in four settings: ERC guidelines 2021 (control), COVID-19-guidelines using videolaryngoscopic intubation (COVID-19-intubation), laryngeal mask (COVID-19-Laryngeal-Mask) or a modified laryngeal mask modified with a shower cap (COVID-19-showercap) to reduce aerosol liberation simulated by a fog machine. Primary endpoint was no-flow-time, secondary endpoints included data on airway management as well as the participants' subjective assessment of aerosol release using a Likert-scale (0 = no release-10 = maximum release) were collected and statistically compared. Continuous Data was presented as mean ± standard deviation. Interval-scaled Data were presented as median and Q1 and Q3.

resultsA total of 120 resuscitation scenarios were completed. Compared to control (Non-VF:11 ± 3 s, VF:12 ± 3 s) application of COVID-19-adapted guidelines lead to prolonged no-flow times in all groups (COVID-19-Intubation: Non-VF:17 ± 11 s, VF:19 ± 5 s;p ≤ 0.001; COVID-19-laryngeal-mask: VF:15 ± 5 s,p ≤ 0.01; COVID-19-showercap: VF:15 ± 3 s,p ≤ 0.01). Compared to COVID-19-Intubation, the use of the laryngeal mask and its modification with a showercap both led to a reduction of no-flow-time(COVID-19-laryngeal-mask: Non-VF:p = 0.002;VF:p ≤ 0.001; COVID-19-Showercap: Non-VF:p ≤ 0.001;VF:p = 0.002) due to a reduced duration of intubation (COVID-19-Intubation: Non-VF:40 ± 19 s;VF:33 ± 17 s; both p ≤ 0.01 vs. control, COVID-19-Laryngeal-Mask (Non-VF:15 ± 7 s;VF:13 ± 5 s;p > 0.05) and COVID-19-Shower-cap (Non-VF:15 ± 5 s;VF:17 ± 5 s;p > 0.05). The participants rated aerosol liberation lowest in COVID-19-intubation (median:0;Q1:0,Q3:2;p < 0.001vs.COVID-19-laryngeal-mask and COVID-19-showercap) compared to COVID-19-shower-cap (median:3;Q1:1,Q3:3 p < 0.001vs.COVID-19-laryngeal-mask) or COVID-19-laryngeal-mask (median:9;Q1:6,Q3:8).

conclusionsCOVID-19-adapted guidelines using videolaryngoscopic intubation lead to a prolongation of no-flow time. The use of a modified laryngeal mask with a shower cap seems to be a suitable compromise combining minimal impact on no-flowtime and reduced aerosol exposure for the involved providers.

Indexed as

Cardiopulmonary ResuscitationCOVID-19Out-of-Hospital Cardiac ArrestAirway ManagementHospitalsHumansIntubation, IntratrachealManikinsAerosol liberationChest compressionCPRExtraglottic airwaySupraglottic airway

Identifiers

PMID37189061
PMCPMC10184619
OpenAlexW4376610474

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.