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Pharyngeal tracheal lumen airway training: Failure to discriminate between esophageal and endotracheal modes and failure to confirm ventilation

1989; Elsevier BV; Volume: 18; Issue: 9 Linguagem: Inglês

10.1016/s0196-0644(89)80459-7

1097-6760

Richard C. Hunt, Clifton A. Sheets, Theodore W. Whitley,

Respiratory Support and Mechanisms

The pharyngeal tracheal lumen (PTL) airway is a new airway control device for emergency medical technicians (EMTs) and paramedics and functions as either an esophageal obturator or an endotracheal tube. We developed a ten-step PTL airway training protocol that included proper airway insertion, patient ventilation, and confirmation of tube placement by auscultation. We then prospectively evaluated the effectiveness of training by testing the ability of 32 EMTs and paramedics to discriminate between esophageal and endotracheal mode placement. Training consisted of a group demonstration followed by supervised individual practice on a Laerdal® Adult Intubation Model. All 70 insertion attempts resulted in esophageal obturator mode placement. As a result, trainees did not have an opportunity to practice discrimination between esophageal and endotracheal placement. Six weeks after initial training, 19 of the entry group were randomly and blidly assigned to ventilate each of two Laerdal® models that had been previously intubated with the PTL, one in esophageal mode and the other in endotracheal mode. In the esophageal mode, 15 of 19 trainees (79%) correctly selected the esophageal port to ventilate, but four (21%) could not decide and abandoned the airway. In the tracheal mode, 16 of 19 trainees (84%) correctly selected the tracheal port to ventilate, one (5%) was unable to decide, and two (10.5%) selected the wrong tube and attempted ventilation with the esophageal port even though the tracheal balloon was completely occluding the airway. Ventilation was confirmed with auscultation in only 50% of the attempts (19 of 38). Our study indicates that the training protocol was inadequate to teach critical decision-making in the use of the PTL airway. Future training should include opportunities for assessing endotracheal placement of the airway and more emphasis on confirmation of ventilation. The pharyngeal tracheal lumen (PTL) airway is a new airway control device for emergency medical technicians (EMTs) and paramedics and functions as either an esophageal obturator or an endotracheal tube. We developed a ten-step PTL airway training protocol that included proper airway insertion, patient ventilation, and confirmation of tube placement by auscultation. We then prospectively evaluated the effectiveness of training by testing the ability of 32 EMTs and paramedics to discriminate between esophageal and endotracheal mode placement. Training consisted of a group demonstration followed by supervised individual practice on a Laerdal® Adult Intubation Model. All 70 insertion attempts resulted in esophageal obturator mode placement. As a result, trainees did not have an opportunity to practice discrimination between esophageal and endotracheal placement. Six weeks after initial training, 19 of the entry group were randomly and blidly assigned to ventilate each of two Laerdal® models that had been previously intubated with the PTL, one in esophageal mode and the other in endotracheal mode. In the esophageal mode, 15 of 19 trainees (79%) correctly selected the esophageal port to ventilate, but four (21%) could not decide and abandoned the airway. In the tracheal mode, 16 of 19 trainees (84%) correctly selected the tracheal port to ventilate, one (5%) was unable to decide, and two (10.5%) selected the wrong tube and attempted ventilation with the esophageal port even though the tracheal balloon was completely occluding the airway. Ventilation was confirmed with auscultation in only 50% of the attempts (19 of 38). Our study indicates that the training protocol was inadequate to teach critical decision-making in the use of the PTL airway. Future training should include opportunities for assessing endotracheal placement of the airway and more emphasis on confirmation of ventilation.