SATIATED
Richard Pilbery
2019-03-28
Chapter 1 Preamble
1.2 Abstract
1.2.1 Introduction
Vomiting and regurgitation are commonly encountered in out-hospital-cardiac arrest (OHCA) with a reported incidence of 20–30%. This is of concern since patients who have suffered an OHCA are already in extremis. If standard suctioning techniques are not sufficient to maintain a clear airway and provide ventilation, then these patients will die, irrespective of the quality of chest compressions and the timeliness of defibrillation. This study aimed to determine whether a short teaching session of the Suction Assisted Laryngoscopy and Airway Decontamination (SALAD) technique, improved paramedics’ ability to successfully intubate a contaminated airway.
1.2.2 Methods
A modified airway manikin with the oesophagus connected to a reservoir of ‘vomit’, and a bilge pump capable of propelling the vomit up into the oropharynx, was used to simulate a soiled airway. The intervention consisted of a brief SALAD training session with a demonstration and opportunity to practice. Participants were randomly allocated into two groups: AAB who made two pre-training intubation attempts and one post-training attempt, and ABB, who made one pre-training and two post-training attempts, to adjust for improvement in performance due to repetition.
1.2.3 Results
In this manikin study, following a brief SALAD training session, more paramedics were able to intubate a soiled airway on their first attempt, compared to those without training (90.2% vs 53.7%, difference of 36.6%, 95%CI 24–49.1%, p<0.001). In addition, the mean difference in time taken to perform a successful intubation between groups was statistically significant for attempts 1 and 2 (mean difference 11.71 seconds, 95% CI 1.95– 21.47 seconds, p=0.02), but not attempts 1 and 3 (mean difference -2.52 seconds, 95% CI -11.64–6.61 seconds, p=0.58)). This result is likely to be confounded by the use of tracheal suction, which only occurred in the post-training attempts, and added additional time to the intubation attempts. There was no statistically significant difference in success rates on the third attempt between AAB and ABB (89.0% vs 86.6%, difference 2.4%, 95%CI 7.6–12.4%, p=0.63).
1.2.4 Conclusion
In this study, the use of the SALAD technique significantly improved first attempt success rates when paramedics were intubating a simulated soiled airway.