editorial advances in airway management and ventilation...

EditorialAdvances in Airway Management and VentilationStrategies in Emergency Medicine

Tomasz Gaszynski,1 Kamil Toker,2 Massimiliano Carassiti,3

Athanasios Chalkias,4,5 and Jestin N. Carlson6

1Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland2Department of Anaesthesia and Reanimation, Kocaeli University Hospital, Umuttepe, Kocaeli, Turkey3School of Medicine, Campus Bio-Medico University, Rome, Italy4MSc “Cardiopulmonary Resuscitation”, Medical School of University of Athens, Athens, Greece5Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece6Allegheny Health Network, Department of Emergency Medicine, Saint Vincent Hospital, USA

Correspondence should be addressed to Tomasz Gaszynski; [email protected]

Received 27 May 2015; Accepted 27 May 2015

Copyright © 2015 Tomasz Gaszynski et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.

Effective management of the airway is a priority in resus-citation efforts and a central issue in emergency medicinefor providing ventilation and oxygenation in critically illpatients. Compared to the controlled conditions of theoperating theatre, airway management in the emergencydepartment is more difficult than in other circumstances;the patient may be in respiratory distress, desaturating, ormay have a compromised airway. In addition, sedationmay have a profound effect on hemodynamically unstablepatients, who may become severely hypotensive and rapidlydeteriorated, while preparation of the patient, environment,and equipment is often challenging [1, 2].

This special issue is published with the intent of servingas a procedure manual for disseminating advances in airwaymanagement and ventilation strategies to all providers whoare involved in emergency care. This issue highlights theexplosive growth of video laryngoscopy which is rapidlybecoming first-line for both in- and out-of-hospital airwaymanagement.

In this issue, S. Fujiwara et al. compare the utility of thePentax-AWS Airwayscope (AWS) with the GlideScope (GS)during chest compressions on an infant manikin.They reportthat the AWS performs better than the GS for endotrachealintubation during ongoing cardiopulmonary resuscitation(CPR).

S. Lee et al. compare intubation performances amongPentax-AWS (AWS), GlideScope (GVL), and Macintoshlaryngoscope (MCL) during mechanical chest compressionin 15∘ and 30∘ left lateral tilt, simulating maternal cardiopul-monary resuscitation.Their study indicates AWS as an appro-priate laryngoscope for airway management of pregnantwomen in lateral tilt.

P. Schoettker and J. Corniche assess the quality andspeed of intubation between the Airtraq with its new iPhoneAirView app and the King Vision in a manikin study. Theyreport that the Airtraq-AirView allows faster identification ofthe landmarks and intubation in a difficult airway manikin,highlighting the need for further research. Also, H. Y. Choi etal. acknowledge the importance of early airway managementin severely ill patients by investigating the efficacy of face-to-face intubation in four different types of laryngoscopes. Inthis study, PentaxAirway Scope andMacintoshwere themostfavorable laryngoscopes in face-to-face intubation.

In an extensive review, M. Barak et al. discuss thecomplexity and difficulties of securing the airway of patientswith maxillofacial trauma and present their approach forairway management of such patients. Despite the recentadvances in emergency airway management techniques,healthcare personnel may still face the “cannot ventilate,cannot intubate” scenario inwhich the specialized equipment

Hindawi Publishing CorporationBioMed Research InternationalVolume 2015, Article ID 425715, 2 pageshttp://dx.doi.org/10.1155/2015/425715

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may be invaluable. In this context, T. Doi et al. investigatedthe influence of upper airway resistance (UAR) duringtranstracheal jet ventilation by comparing a manual jetventilator (MJV) and the oxygen flush device of the anestheticmachine (AM). In their model, the influence of choked flowfrom the Venturi effect was minimal under all UAR settingswith the MJV, but the AM could not deliver sufficient flow.

J. N. Carlson et al. perform a proof of concept studyto determine if portable motion technology could identifythe motion components of endotracheal intubation betweennovice and experienced providers using inertial measure-ment units (IMUs) to record the movements during endo-tracheal intubation. They conclude that portable IMUs canbe used to detect differences in movement patterns betweennovice and experienced providers, suggesting their value ineducational efforts.

Field intubation is a complex process and time to intu-bation, number of attempts, and hypoxia have all beenshown to correlate with increases in morbidity and mor-tality. B. Boehringer et al. investigate the “Impact of VideoLaryngoscopy on Advanced Airway Management by CriticalCare Transport Paramedics and Nurses Using the CMACPocket Monitor” in field intubation. They report that theCMAC video laryngoscope improves success rates in airwaymanagement, indicating that video laryngoscopes may becrucial in out-of-hospital airway management.

As many challenges are augmented in the acute setting,emergency providers must be skilled with airway man-agement [3]. Advances in airway management technologyhave helped to improve many aspects of emergency airwaymanagement; however, expertise alone cannot make up forthe lack of the right equipment or adequate understandingof new technologies. Conversely, these new technologiesdo not obviate the need for a solid foundation in airwaymanagement techniques. Up to 4% of patients who undergoemergent intubation suffer a cardiac arrest [4], indicating thata more complete understanding of the interaction betweenclinical experience and technological advances is needed toincrease the effectiveness and improve the safety of patientsundergoing emergency airway management. This specialissue helps to expand our knowledge of this intersectionwithin emergency airway management.

Tomasz GaszynskiKamil Toker

Massimiliano CarassitiAthanasios Chalkias

Jestin N. Carlson

References

[1] T. M. Cook, N. Woodall, J. Harper, and J. Benger, “Majorcomplications of airway management in the UK: results of theFourth National Audit Project of the Royal College of Anaes-thetists and the Difficult Airway Society. Part 2: intensive careand emergency departments,”British Journal of Anaesthesia, vol.106, no. 5, pp. 632–642, 2011.

[2] A. N. Thomas and B. A. McGrath, “Patient safety incidentsassociated with airway devices in critical care: a review of

reports to the UK National Patient Safety Agency,” Anaesthesia,vol. 64, no. 4, pp. 358–365, 2009.

[3] J. L. Apfelbaum, C. A. Hagberg, R. A. Caplan et al., “Practiceguidelines for management of the difficult airway: an updatedreport by the American Society of Anesthesiologists Task ForceonManagement of theDifficult Airway,”Anesthesiology, vol. 118,no. 2, pp. 251–270, 2013.

[4] A. C. Heffner, D. S. Swords, M. N. Neale, and A. E. Jones, “Inci-dence and factors associated with cardiac arrest complicatingemergency airway management,” Resuscitation, vol. 84, no. 11,pp. 1500–1504, 2013.

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