Orotracheal tube versus supraglottic devices in biological, chemical and radiological disasters: meta-analysis in manikin-based studies / Tubo orotraqueal versus dispositivos supraglóticos en desastres biológicos, químicos y radiológicos: metaanálisis en estudios de maniquíes

ABSTRACT Objective: To compare the mean time of orotracheal intubation and insertion of supraglottic airway devices, considering healthcare providers wearing waterproof overall, gloves, boots, eye protection and mask at the Chemical, Biological, Radiological and Nuclear context in simulation setting. Methods: Six databases were searched. The selected studies were put in a pool of results using a random-effects meta-analysis, with standardized mean differences and calculation of 95% confidence intervals. Results: Nine observational studies were included. Regarding reducing time to provide ventilatory support, subgroup analyses were made. The emergency setting subgroup: -12.97 [-16.11; -9.83]; I2 = 64%. The surgery setting subgroup: -14.96 [-18.65; -11.27]; I2 = 75%. Another analysis was made by reproductive methodology subgroups. Ophir's subgroup: -15.70 [-17.04; -14.37]; I2 = 0%. All meta-analyses had orotracheal tube as comparator. Conclusion: Moderate level of evidence was in favor of insertion of supraglottic devices because of fast application.

RESUMEN Objetivo: Comparar el tiempo medio de intubación orotraqueal e inserción de dispositivos de vía aérea supraglótica, considerando profesionales de la salud con overol impermeable, guantes, botas, protección ocular y mascarilla en el contexto químico, biológico, radiológico y nuclear en un escenario de simulación. Métodos: Se realizaron búsquedas en seis bases de datos. Los estudios seleccionados se pusieron en un conjunto de resultados mediante un metaanálisis de efectos aleatorios con diferencias de medias estandarizadas y cálculo de intervalos de confianza del 95%. Resultados: Se incluyeron nueve estudios observacionales. Con respecto a la reducción del tiempo para proporcionar soporte ventilatorio, se realizaron análisis de subgrupos. El subgrupo del entorno de emergencia: -12,97 [-16,11; -9,83]; I2 = 64%. El subgrupo del entorno quirúrgico: -14,96 [-18,65; -11,27]; I2 = 75%. Otro análisis fue realizado por subgrupos de la metodología reproductiva. Subgrupo Ophir: -15,70 [-17,04; -14,37]; I2 = 0%. En todos los metaanálisis, se utilizó el tubo orotraqueal como comparador. Conclusión: Nivel de evidencia moderado a favor de la inserción de dispositivos supraglóticos debido a la aplicación más rápida.

The need to standardize use of the newly deceased in medical trainings

OBJECTIVES: The present study aimed to identify the characteristics of use of the deceased in invasive training and the bioethical principles that govern this practice. In this context, it has become imperative to deduce which professional skills are critical to develop. METHODS: A prospective study investigated a cadaver's use in medical (and related) schools through a questionnaire, which was made available for 48 hours on social networks (Facebook and LinkedIn) to groups of doctors and medical students using a communication app (WhatsApp). The inclusion criteria were being a medical student or a doctor. Cases in which the answers to the questionnaire were inadequate, or when the student had reason to withdraw, were excluded. Each participant could only answer the questionnaire once, and could not modify the responses after submitting it. RESULTS: A disproportionate relationship was found regarding the replacement of the newly deceased by other means (such as dummies and simulators). This outcome suggests that there is no substitution, concomitant with the importance of a prior request for consent from the patient and/or subsequent consent from family members. CONCLUSION: According to the findings, the significance of—and need for—training is undeniable. Hence, it is urgent to normalize the practice and definition of the ethical limitations of medical conduct.

Basic Life Support: an accessible tool in layperson training

SUMMARY OBJECTIVES 1) To evaluate the efficiency of a new method of training laypeople on cardiopulmonary resuscitation (CPR). 2) To assess previous knowledge of the participants. METHODS Instructors were trained according to the 2015 American Heart Association Guidelines, with emphasis on CPR. Dummies made with PET bottles were used, and a questionnaire was applied to the participants before and after training. Statistical analysis was performed in the R commander program. Participants with incomplete documents were excluded from the study. RESULTS Out of 101 participants, 96 were included: 69 lay people, 17 health professionals, and ten health students. There was an improvement in the overall performance after training (mean pre: 62.7%, mean post: 75.8%, p <0.01), also present in the following main concepts: "mouth-to-mouth breathing is not necessary" (p <0.01), "risk of contamination" (p <0.01), "compression technique" (p <0.01). The concepts "recognition of severity" and "what is chest compression" did not improve, but had good pre-test means, 96.8% and 81.2%. There was no statistical difference in the knowledge between the groups (laypeople vs. health professionals and students, pre=0,06 e post=0,33). CONCLUSION The tools used in training were efficient. However, further studies are necessary to assess the long-term impact of this intervention.

RESUMO OBJETIVOS 1) Avaliar a eficiência da nova proposta de ensino de ressuscitação cardiopulmonar (RCP) à população leiga. 2) Avaliar o conhecimento prévio dos participantes da oficina. MÉTODOS Instrutores foram treinados de acordo com as diretrizes de 2015 da American Heart Association com enfoque na RCP. Utilizaram-se manequins confeccionados com garrafas PET, além de aplicação de questionário aos participantes antes e depois do treinamento. A análise estatística foi realizada no programa R commander. Foram excluídos do estudo participantes com documentos incompletos. RESULTADOS Dos 101 participantes, 96 foram incluídos: 69 leigos, 17 profissionais da saúde e dez estudantes da área da saúde. Houve melhora do desempenho geral após o treinamento (média pré: 62,7%; média pós: 75,8%; p<0,01), presente também nos seguintes conceitos principais: "respiração boca a boca não é necessária" (p<0,01), "risco de contaminação" (p<0,01), "técnica de compressão" (p<0,01). Os conceitos "reconhecimento de gravidade" e "o que é massagem cardíaca" não apresentaram melhora, mas tiveram boas médias pré-teste: 96,8% e 81,2%. Não se verificou diferença estatística no conhecimento entre grupos (leigos vs profissionais e estudantes da saúde, ppre=0,06 e ppos=0,33). CONCLUSÃO As ferramentas utilizadas no treinamento se mostraram eficientes. No entanto, novos estudos são necessários para avaliar o impacto no longo prazo.

Relationship between image quality of PET/CT in automatic tube current modulation and effective dose / 中华核医学与分子影像杂志

Objective To investigate the relationship between image quality of PET/CT in automatic tube current modulation and effective dose(ED) of patients and to determine the optimal acquisition scheme.Methods Scanning was performed on anthropomorphic phantom RS-550 using GE Discovery ST-16 or Discovery Elite PET/CT.The same CT acquisition conditions was used:tube voltage 120 kV,pitch 1.375,rotation speed 0.8 s,noise index ranged from 8 to 30,interval 2,automatic tube current low limit 30 mA,high limit ranged from 200 to 350 mA,interval 50 mA.The images were analyzed,and the noise,signal to noise ratio (SNR) and figure of merit (FOM) of main organs in the abdomen were calculated.The relationship between image quality and ED was analyzed.Two-sample t test was used for data analysis.Results The noise of each organ decreased significantly along with the increase of ED until the ED of ST-16 increased to 15 mSv or Elite increased to 12 mSv,then the image noise decreased gently.SNR of each organ image increased along with the increase of ED.The FOM of liver decreased along with the increase of ED,while the FOM of other organs did not change significantly with ED.All image indicators of Elite PET/CT were better than ST-16 PET/CT at the same ED (5-20 mSv),though there was no significant difference (t:0.133-4.701,all P＞0.05).When ED was 5 mSy,the noise of liver with ST-16 was 12.0％ (28.9 vs 25.8)higher than that with Elite,and the SNR and FOM of liver with Elite was 13.9％ (4.1 vs 3.6) and 66.7％ (0.50 vs 0.30) higher than that with ST-16,respectively.Conclusion When the ED caused by the 2 PET/CT systems was between 5-20 mSy,the image quality is improved along with the ED increasing in a certain range.

Advances in clinical application of 3D printing technology in spinal surgery / 国际外科学杂志

The application of 3D printing technology in medicine may greatly affect the surgical methods of spinal surgery.Currently,3D printing technology has been applied to preoperative and intraoperative.Before surgery,3D printing can be used to create precise anatomical models of spinal deformities.In addition,these anatomical models can be used to plan and simulate complex spinal lesions.3D printed anatomical models can provide better understanding of anatomy than CT or MRI.During surgery,3D printing has been used to create surgical guidance systems,create templates and customize specific shapes of implants.Although 3D printing technology still faces the challenge of expensive equipment and materials,this technology has many advantages such as improving patient prognosis and reducing the radiation dose of patients.This article mainly introduces the clinical application and future development of 3D printing technology in spine surgery.

Advances in clinical application of 3D printing technology in spinal surgery / 国际外科学杂志

The application of 3D printing technology in medicine may greatly affect the surgical methods of spinal surgery. Currently, 3D printing technology has been applied to preoperative and intraoperative. Before surgery, 3D printing can be used to create precise anatomical models of spinal deformities. In addition, these anatomical models can be used to plan and simulate complex spinal lesions. 3D printed anatomical models can provide better understanding of anatomy than CT or MRI. During surgery, 3D printing has been used to create surgical guidance systems, create templates and customize specific shapes of implants. Although 3D printing technology still faces the challenge of expensive equipment and materials, this technology has many advantages such as improving patient prognosis and reducing the radiation dose of patients. This article mainly introduces the clinical application and future development of 3D printing technology in spine surgery.

Comparison of the GlideRite to the conventional malleable stylet for endotracheal intubation by the Macintosh laryngoscope: a simulation study using manikins

OBJECTIVE: To compare the effectiveness of the GlideRite stylet with the conventional malleable stylet (CMS) in endotracheal intubation (ETI) by the Macintosh laryngoscope. METHODS: This study is a randomized, crossover, simulation study. Participants performed ETI using both the GlideRite stylet and the CMS in a normal airway model and a tongue edema model (simulated difficult airway resulting in lower percentage of glottic opening [POGO]). RESULTS: In both the normal and tongue edema models, all 36 participants successfully performed ETI with the two stylets on the first attempt. In the normal airway model, there was no difference in time required for ETI (TETI) or in ease of handling between the two stylets. In the tongue edema model, the TETI using the CMS increased as the POGO score decreased (POGO score was negatively correlated with TETI for the CMS, Spearman’s rho=-0.518, P=0.001); this difference was not seen with the GlideRite (rho=-0.208, P=0.224). The TETI was shorter with the GlideRite than with the CMS, however, this difference was not statistically significant (15.1 vs. 18.8 seconds, P=0.385). Ease of handling was superior with the GlideRite compared with the CMS (P=0.006). CONCLUSION: Performance of the GlideRite and the CMS were not different in the normal airway model. However, in the simulated difficult airway model with a low POGO score, the GlideRite performed better than the CMS for direct laryngoscopic intubation.

Comparison between an instructor-led course and training using a voice advisory manikin in initial cardiopulmonary resuscitation skill acquisition

OBJECTIVE: We compared training using a voice advisory manikin (VAM) with an instructor-led (IL) course in terms of acquisition of initial cardiopulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. METHODS: This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and distributed them randomly into two groups: the IL group (n=41) and the VAM group (n=37). In the IL-group, participants were trained in “single-rescuer, adult CPR” according to the American Heart Association's Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. RESULTS: The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; P=0.396). CONCLUSION: Both methods, the IL training using a practice-while-watching video and the VAM training, facilitated initial CPR skill acquisition, especially in terms of correct chest compression.

Human landing impact safety studies:a method analysis / 军事医学

The characteristics of human body impact response and several impact test objects are analyzed.The strengths and weaknesses of different research methods applied to different human landing impact test objects are contrasted.The relevant experimental findings and evaluation criteria of domestic and international tests on human landing impact are analyzed.The results show that the selected human substitutes in several research tests have some flaws, so it is urgent to formulate regulations on the load characteristics, individual characteristics, the posture of the test object and the protection status, and it is recessary to study impact tolerance and protective methods of corresponding operating personnel for different transports.

Adult head and face models:localization observation of the angular artery and its clinical significance / 中国组织工程研究

BACKGROUND:Nasolabial fold flap has been widely used in clinical surgery. The facial artery anatomy has been widely used in clinical research. Angular artery dissection is becoming more and more important to nasolabial groove area surgery, but at present, there is a lack of anatomical analysis of internal angular artery. OBJECTIVE:To study the anatomy of the angular artery, and to provide anatomical data for protecting the nasolabial flap during surgery. METHODS:Twenty sides of adult cadaver specimens on head and face were dissected. A reference coordinate system was made based on the line between the connection of two medial angles of eyes (axis X) and the facial midline line (axis Y). The location of the angular artery was measured taking A-F as reference points. RESULTS AND CONCLUSION:(1) The slant angles of the angular artery on BC section, CD section, DE section and EF section were (11.1±4.3)°, (34.1±8.8)°, (21.5±10.5)°, and (17.0±4.7)°, respectively. (2) The angular artery sourced from facial artery was more than it sourced from ophthalmic artery. The diameter of right blood vessel was larger than that of left side. (3) The angular artery sourced from ophthalmic artery comes from the location which extended 8.1 mm to both sides from the point which was 10 mm up from the intersection of facial medial angle of eyes connection and midline. The blood vessel diameter of the starting point was (0.7±0.2) mm. The whole range was 20.1 mm. (4) The angular artery sourced from facial artery comes from the location which extended 25.8 mm to both sides from the point which was 40 mm down to the intersection of facial medial angle of eyes connection and midline. The blood vessel diameter of the starting point was (0.9±0.3) mm. Point to the wing of nose the lateral distance was (5.0±1.2) mm. The whole range was 68.7 mm. The surface projecting of angular artery coming from research results provided anatomic basis for surgery of nasolabial flap.

Differences in Hands-off Time According to the Position of a Second Rescuer When Switching Compression in Pre-hospital Cardiopulmonary Resuscitation Provided by Two Bystanders: A Randomized, Controlled, Parallel Study

The change of compressing personnel will inevitably accompany hands off time when cardiopulmonary resuscitation (CPR) is performed by two or more rescuers. The present study assessed whether changing compression by a second rescuer located on the opposite side (OS) of the first rescuer can reduce hands-off time compared to CPR on the same side (SS) when CPR is performed by two rescuers. The scenario of this randomized, controlled, parallel simulation study was compression-only CPR by two laypersons in a pre-hospital situation. Considering sex ratio, 64 participants were matched up in 32 teams equally divided into two gender groups, i.e. , homogenous or heterogeneous. Each team was finally allocated to one of two study groups according to the position of changing compression (SS or OS). Every team performed chest compression for 8 min and 10 sec, with chest compression changed every 2 min. The primary endpoint was cumulative hands-off time. Cumulative hands-off time of the SS group was about 2 sec longer than the OS group, and was significant (6.6 +/- 2.6 sec vs. 4.5 +/- 1.5 sec, P = 0.005). The range of hands off time of the SS group was wider than for the OS group. The mean hands-off times of each rescuer turn significantly shortened with increasing number of turns (P = 0.005). A subgroup analysis in which cumulative hands-off time was divided into three subgroups in 5-sec intervals revealed that about 70% of the SS group was included in subgroups with delayed hands-off time > or = 5 sec, with only 25% of the OS group included in these subgroups (P = 0.033). Changing compression at the OS of each rescuer reduced hands-off time compared to the SS in prehospital hands-only CPR provided by two bystanders.

The Effect of Counting Numbers out for Giving Breaths on the Interrupting Time and Fraction of Chest Compressions in 2-rescuer Cardiopulmonary Resuscitation: A Manikin Pilot Study

PURPOSE: The aim of this study was to estimate the effect of counting numbers out for giving breaths on the interruption time (IT) of chest compressions (CCs) and chest compression fraction (CCF) in the 2-rescuer cardiopulmonary resuscitation (CPR). METHODS: Thirty medical students were enrolled in this randomized control simulation study, and were randomly divided into the control group and the study group. Both groups performed 2-rescuer CPR for 5-cycles with giving breaths using a bag-mask. Only participants in the study group were instructed to count numbers out for each breath verbally ("one, two") at the end point of each inspiration period and immediately perform CCs at the point of counting "two". RESULTS: However, no differences in terms of depth, rate, incorrect location, and duty cycle of CCs, as well as ventilation volume of each breath, time to delivery of two breaths, and counts of breathing during 1 minute were observed between the two groups. CONCLUSION: The study group had significantly shorter IT and higher CCF compared with the control group. And no significant differences in the other measured parameters of CPR quality were observed between the two groups.

Educational suitability of endotracheal intubation using a video-laryngoscope / 한국의학교육

PURPOSE: The purpose of this study is to determine the educational suitability of the video-laryngoscope in teaching endotracheal intubation to students. METHODS: Medical students participated in a course on the use of a Macintosh direct laryngoscope and McGrath MAC videolaryngoscope for intubation. The course comprised a 1-hour lecture and 30 minutes of practice on a manikin. After the course, in each of the three simulated patient scenarios-normal airway, cervical spine fixation, and tongue edema-time to intubate, success rate, and chance of complications were measured. A questionnaire was administered before and after the course to determine the suitability of intubation by video-laryngoscope for a medical education course. Also, changes in the perception and stance on the video-laryngoscope were evaluated. RESULTS: Time to intubate decreased as attempts were repeated. The first-attempt success rate in the cervical spine fixation scenario was higher using the video-laryngoscope (p=0.028). Rates if tooth injury were lower in the cervical spine fixation (p=0.005) and tongue edema scenarios (p=0.021) using the video-laryngoscope. Based on the questionnaires, students responded positively with regard to their knowledge of the video-laryngoscope, its practical value, and its suitability for medical education (p<0.001). Also, the preference for the video-laryngoscope was greater (p=0.044). Students felt that repeated attempts and feedback on intubation were helpful. CONCLUSION: The students' evaluations and surveys showed positive results to intubation by video-laryngoscope. Thus, based on its suitability for medical education it is reasonable to consider learning intubation using the video-laryngoscope.

Reconstruction and application of three-dimensional digital visual model of tooth and skull / 中国组织工程研究

BACKGROUND:Because the content of oral and maxil ofacial anatomy is various and complex, only the traditional way of multimedia cannot display the anatomical structures from multi-angle and al-round. The development of virtual reality technology in oral and maxil ofacial anatomy of three-dimensional reconstruction research is rapid, causes the attention of many scholars, and has become a hot spot. OBJECTIVE:To develop a three-dimensional digital model of tooth, dentition and skul , and establish a multimedia database of oral and maxil ofacial anatomy to facilitate network sharing and information dissemination so as to provide new method for teaching of basic and clinical oral medicine. METHODS:Extracted teeth with intact crown and root, dentition and skul were chosen. Each specimen was taken at horizontal and vertical direction by the camera in the center of turntable. Al the images obtained were treated using Photoshop CS5 for dressing and compression. The image data were input into The VR Worx system, fol owed by parameters and hotspots setting and the compression. Final y, the three-dimensional digital models were reconstructed and output with QuickTime VR format into disk. RESULTS AND CONCLUSION:Three-dimensional digital models of tooth and skul were constructed with photography and the VR Worx 2.6 software, which could faithful y reproduce the anatomical characteristics of teeth, dentition and skul s, and facilitate researchers to rotate and scale for observation. Also, it was easy for hotspot-marking. On the platform of digital photography and The VR Worx software, it is feasible to establish the three-dimensional digital model of tooth and skul . This approach is the entity reconstruction, and the reconstructed model appears clear, vivid, and is easy to be saved and promoted.

Numerical research on the deposition of suspended particulate matter in respiratory tract / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo study the deposition of suspended particles in the respiratory tract during human breathing.METHODSBased on CT data, three dimensional finite element model of an anatomically accurate respiratory tract, including the nasal cavity, oral cavity, pharynx, larynx, trachea and parts of tracheobronchial tree, is established. Numerical analysis for the deposition of suspended particles in the respiratory tract was conducted. RESULTSThe velocity and pressure distributions of airflow in the respiratory tract were obtained, as well as the particles path and their deposition law.CONCLUSION Respiratory tract plays an important role in filtering suspended particles in the air during breathing. The main deposition sites of the particles were at the front of the inferior turbinate and the posterior pharyngeal wall.

Does simulated training improve medical students’ knowledge on cardiac life support? A study comparing simulated versus traditional teaching at the International Medical University

Background: At the International Medical University (IMU), a half day cardiac life support teaching session was provided to fourth year medical students which included training on the use of the defibrillator machine, how to handle cardiac or respiratory arrest and drugs used for resuscitation. A new CLS (cardiac life support) training session was introduced and increased to a oneday course where students were given practical training first, which included 5 stations (airway equipment, mega codes, drugs for resuscitation, defibrillator use and cardiac rhythm identification) , MCQ (multiple choice questions) test and a mega code (practical)assessment. Objective: To evaluate the students’ knowledge on cardiac resuscitation after a change in the delivery of the cardiac life support training (CLS). Methodology: Group I, consisted of 82 students taught using the traditional teaching and Group II consisted of 77 students taught using hands on simulation. The students in both groups had an online manual to read prior to the session, were given an identical written exam six months after the CLS training. Group II, however, had an online pre-test. Results: There was a statistical difference in the final mean marks between the two groups with group II scoring higher (67.3) than group 1 (62.1). No significant marks difference was noted between male and female students for both the cohorts. Conclusion: There is a significant difference in medical students’ knowledge when cardiac life support is taught using simulation. IMU has adopted the new teaching method with simulated training for the cardiac life support courses with plans to implement higher fidelity and technology to the existing simulated teaching in other areas of medicine.

ACLS Ventilation Skills-Education Effect of Compression Adjusted Ventilation: A Manikin Study

PURPOSE: Previous study demonstrated that compression adjusted ventilation (CAV) is helpful in maintaining an adequate ventilation rate during cardiopulmonary resuscitation (CPR). We conducted this study in order to verify that CAV is also a useful educational method for maintenance of an adequate ventilation rate. METHODS: Volunteers who received education on CPR guidelines were randomly assigned to two groups. In the conventional ventilation (CV) group, participants performed ventilation in accordance with conventional guidelines. In the CAV group, the ventilation rate was adjusted in line with the compression rate (one ventilation per 12 chest compressions). Then, participants performed CPR using a cardiac arrest model with an advanced airway. They performed chest compression and ventilation. All participants performed CPR immediately after their instruction (test 1) and performed it again after four weeks (test 2). RESULTS: Data were collected from 60 participants. In the CAV group, proportion of adequacy of ventilation rates was higher compared with the CV group in both test 1 (CV: 18.8% vs. CAV: 57.1%, p=0.001) and test 2 (CV: 25.0% vs. CAV: 71.4%, p<0.001). In addition, no significant difference was observed between the compression rates of the two groups in test 1. However, in test 2, a significant decline was observed in the CV group (p=0.003). CONCLUSION: CAV is a more useful educational method for maintenance of an adequate ventilation rate.

A Comparison of Passive Release Technique and Minimal Occlusive Volume Technique for Endotracheal Tube Cuff Inflation

PURPOSE: Inflation of an endotracheal tube cuff with adequate pressure is an important procedure. Passive release technique (PRT) is a useful and convenient method for inflating the cuff. To date, no study comparing this method with minimal occlusive volume technique (MOVT), one of the most commonly used methods for inflating the cuff, has been reported. We conducted this study for comparison of effectiveness, difficulty, and preference between the two methods. METHODS: We conducted a prospective, crossover, randomized study in which participants used each technique, one at a time. Participants inflated the cuff of an endotracheal tube inserted into a manikin after receiving brief education on use of the two methods. After inflating the cuff using each method, pressure and volume of the inflated cuff were measured using a portable manometer and syringes, respectively. Then, difficulty of each method was investigated using the visual analogue scale (VAS) and preference for each method was investigated. RESULTS: A total of 47 participants were enrolled in the study. The mean pressure between the two methods was not statistically different (p=0.27). However, adequate pressure was achieved in 37 (78.7%) and 16 (34.0%) of participants in PRT and MOVT, respectively (p<0.01). The mean volume was 6.0+/-0.4 ml in PRT and 5.7+/-0.6 ml in MOVT (p<0.01). The VAS score for diffculty was 17.7+/-15.8 in PRT and 76.0+/-15.8 in MOVT (p<0.01). Preference for PRT was 46(97.9%) and that for MOVT was 1 (2.1%). CONCLUSION: PRT is an easier, more preferred, and more effective method for cuff inflation than MOVT.

The Superiority of the Laryngeal Mask Airway to the Pentax(R)AirwayScope Used by an Unskilled Pre-hospital Rescuer: A Randomized, Controlled, Crossover Mannequin Study

INTRODUCTION: Recent studies have highlighted the use of a video laryngoscope, a promising airway device that enables faster intubation than a Macintosh laryngoscope without the cessation of chest compressions. The aim of this study was to compare the performance of a Pentax AirwayScope (AWS) with that of a laryngeal mask airway (LMA) when utilized by unskilled personnel in a mannequin model while performing chest compressions. METHODS: We conducted a randomized controlled crossover trial to compare the effects of these two airway devices. A total of 36 participants performed intubation on a mannequin, with each device in both common and moderate level of difficulty airway scenarios. The time to successful ventilation, rate of ventilation success, and subjective difficulty in manipulating the devices were compared. RESULTS: In a scenario with airways of common difficulty, the LMA had a shorter time interval to successful ventilation than the AWS (13.6 vs. 25.2 seconds, respectively, p<0.001). In a scenario with moderately difficult airways, the LMA was also shorter than the AWS (14.5 vs. 26.9 seconds, respectively, p<0.001). For every level of difficulty for the airway, the LMA showed a higher successful ventilation rate and a lower extent of difficulty in device operation than the AWS (p<0.05). CONCLUSION: In the pre-hospital setting, using the LMA could enable an unskilled rescuer to establish airway patency more rapidly. LMA might also be safer and easier for operation than the AWS.

Nurses' Cardiopulmonary Resuscitation Performance during the First 5 minutes in In-Situ Simulated Cardiac Arrest

PURPOSE: The purpose of this study was to analyze the cardiopulmonary resuscitation skills and teamwork of nurses in simulated cardiac arrests in the hospital. METHODS: A descriptive study was conducted with 35 teams of 3 to 4 registered nurses each in a university hospital located in Seoul. A mannequin simulator was used to enact simulated cardiac arrest. Assessment included critical actions, time elapsed to initiation of critical actions, quality of cardiac compression, and teamwork which comprised leadership behavior and communication among team members. RESULTS: Among the 35 teams, 54% recognized apnea, 43% determined pulselessness. Eighty percent of the teams compressed at an average elapsed time of 108+/-75 seconds with 35%, 36%, and 67% mean rates of correct compression depth, rate, and placement, respectively. Thirty-seven percent of the teams defibrillated at 224+/-67 seconds. Leadership behavior and communication among team members were absent in 63% and 69% of the teams, respectively. CONCLUSION: The skills of the nurses in this study cannot be considered adequate in terms of appropriate and timely actions required for resuscitation. Future resuscitation education should focus on improving the quality of cardiopulmonary resuscitation including team performance targeting the first responders of cardiac arrest.