Evaluation of airway device usage duringcardiopulmonary resuscitation i̇mplementation

DADAKÇI Yağmur Can. Evaluation of Airway Device Usage During Cardiopulmonary Resuscitation İmplementation, Hacettepe University Faculty of Medicine, Department of Anesthesiology and Reanimation, Residency Thesis, Ankara, 2018. The optimal airway management strategy during cardiopulmonary resuscitation (CPR) has not been determined yet. The widely acknowledged practice is using a stepwise approach towards more advanced techniques with minimalized interruptions to high quality chest compressions. Airway management varies depending on patient related factors and skills of the rescuer. The aim of this study was to investigate the airway management approach of clinicians, working in intensive care units, emergency services and anesthesiology clinics, during cardiopulmonary resuscitation. Following ethical committee approval, we conducted an online survey of clinicians working in intensive care units, emergency services and anesthesiology clinics of university and training and research hospitals in Turkey between 01.05.2017 and 01.07.2017. The survey questioned data regarding airway management strategies during CPR, the equipment and techniques used, preferred rescue techniques in case of difficult airway, and the usage of end-tidal carbon dioxide. Three hundred and fifty-seven clinicians responded to the survey. Twentyfour percent of the clinicians reported that they interrupt chest compressions ≥5 seconds for an intubation attempt. The interruption times were significantly shorter in specialists and anesthesiologists compared to residents and non-anesthesiology specialties respectively. When faced with a difficult intubation, 37% of the clinicians reported that they perform ≥3 intubation attempts before trying an alternative technique. Specialists were much likely to perform < 3 attempts compared to general practitioners and residents. Despite reporting less intubation attempt times and being more experienced, specialists were more likely to use SAD as an alternative to intubation during CPR. The ratio of clinicians who believed that they were experienced enough in videolaryngoscopy and emergency front of neck access were 35.8% and 15.6% respectively. Thirty-three percent of clinicians reported that they have never used end-tidal carbon dioxide monitoring during CPR. Both the 2015 ERC and AHA resuscitation guidelines emphasize the importance of uninterrupted and high-quality chest compressions for the success of CPR. Therefore, the usage of alternative techniques like the SAD can be recommended instead of interrupting chest compressions for several intubation attempts. The data of our study suggests that anesthesiologists and specialists (irrespective of their medical specialty) were more consistent with the recommendations of the current resuscitation guidelines compared to other specialties and residents&general practitioners respectively. There remains room for improvement and update of knowledge and skills of clinicians who can face with cardiopulmonary resuscitation frequently during their daily practice. Keywords: Cardiopulmonary resuscitation, airway management, supraglottic airway device