병원전단계에서의 응급구조사에 의한 기도유지 및 호흡처치에 대한 시행 현황에 관한 조사

김재혁,조진성,임용수,이수복,현성열,김진주,이근,양혁준,류일 대한응급의학회 2011 대한응급의학회지 Vol.22 No.2

Purpose: Airway management and ventilation at the prehospital stage are essential and very critical to patient welfare. In Korea, however, methods other than the use of a bag valve mask are hardly used at the pre-hospital stage by emergency medical technicians (EMTs). This study survey the current state of airway management and respiratory first aid at the pre-hospital stage. Methods: A questionnaire survey of 356 EMTs was conducted by distributing questionnaires directly to first-class EMTs who participated in clinical training at emergency centers or by sending questionnaires and receiving answers by E-mail. The questionnaire solicited information concerning general characteristics of EMTs, monthly frequency of pre-hospital airway management of patients and the will of EMTs. Subjects were divided into two groups according to governmental subdivision or presence of training within 1-year. Results: Concerning airway management and ventilation at the pre-hospital stage, the use of methods other than nasal prong and simple mask was very rare. As to the reasons,the respondents mentioned the shortage of manpower and lack of knowledge/experience. There was no significant difference in the ratio of pre-hospital airway management between urban and suburban/rural settings. Training within 1-year was not related to increased enforcement of airway management. Conclusion: In Korea, pre-hospital airway management is not well implemented by EMTs. Causes are deficiency of rescuer, less actual patient treatment experience and deficiency of knowledge/experience. Education and work experience can influence pre-hospital airway management. But,most pre-hospital airway management is unaffected by education and work experience.

The Effect of a Dedicated Intensivist Staffing on Emergency Airway Management by Rapid Response Team in General Ward

( Jisu Yu ),( Da-hye Kim ),( Eun-joo Choi ),( Sang-bum Hong ),( Jin-won Huh ),( Chae-man Lim ),( Younsuck Koh ),( Dong Kyu Oh ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.0

Background Although the rapid response system is widely spreading, many of them are operated without a dedicated staff. We investigated the changes in emergency airway management by rapid response team (RRT) after a dedicated intensivist staffing. Methods A single-center retrospective non-interventional study was performed at a tertiary hospital. Patients who required emergency airway management by RRT between January 2015 and December 2019 were included. We divided the study period into two eras, non-staff-led (from January 2015 to February 2018, n=971) and staff-led (from March 2018 to December 2019, n=651), and compared variables related to airway management. Results Among 1,622 patients, mean age was 63.0 years and male were 64.2% (n=1,042). Difficult airway was assessed in 306 (18.9%) patients. The first pass success rate was significantly higher (85.9% in the non-staff-led era vs. 89.2% in the staff-led era, p=0.047) and the post-intubation hypoxemia was less common (7.2% vs. 4.2%, p=0.018) in the staff-led era. The ROX index at the time of intubation was higher in the staff-led era (median [interquartile range]; 4.6 [3.4-7.6] vs. 5.1 [3.6-8.5], p=0.013), which suggests the decision for intubation was made earlier. In addition, the use of rapid sequence intubation (9.4% vs. 34.4%, p<0.001) and videolaryngoscope (88.2% vs. 97.1%, p<0.001) were also more frequent in the staff-led era. In multivariate analysis, factors associated with first pass success were the experience of clinician (odds ratio [95% confidence interval]; 2.375 [1.662-3.393], p<0.001 for intensive care unit fellows and 14.316 [1.908-107.415], p=0.010 for RRT staff, relative to internal medicine residents), the use of videolaryngoscope (5.462 [3.428-8.701], p<0.001) and rapid sequence intubation (3.325 [1.839- 6.012], p<0.001), and difficult airway (0.331 [0.224-0.489], p<0.001). Conclusions A dedicated intensivist staffing to RRT was associated with improved emergency airway management in general ward.

Implementation and Outcomes of a Difficult Airway Code Team Composed of Anesthesiologists in a Korean Tertiary Hospital: A Retrospective Analysis of a Prospective Registry

정희준,Choi Ji Won,Kim Duk Kyung,Lee Sang Hyun,Lee Soo Yeon 대한의학회 2022 Journal of Korean medical science Vol.37 No.3

Background: In 2017, we established an airway call (AC) team composed of anesthesiologists to improve emergency airway management outside the operating room. In this retrospective analysis of prospectively collected data from the airway registry, we describe the characteristics of patients attended to and practices by the AC team during the first 4 years of implementation. Methods: All AC team activations in which an airway intervention was performed by the AC team between June 2017 and May 2021 were analyzed. Results: In all, 359 events were analyzed. Activation was more common outside of working hours (62.1%) and from the intensive care unit (85.0%); 36.2% of AC activations were due to known or anticipated difficult airway, most commonly because of acquired airway anomalies (n = 49), followed by airway edema or bleeding (n = 32) and very young age (≤ 1 years; n = 30). In 71.3% of the cases, successful intubation was performed by the AC team at the first attempt. However, three or more attempts were performed in 33 cases. The most common device used for successful intubation was the videolaryngoscope (59.7%). Tracheal intubation by the AC team failed in nine patients, who then required surgical airway insertion by otolaryngologists. However, there were no airway-related deaths. Conclusions: When coupled with appropriate assistance from an otolaryngologist AC system, an AC team composed of anesthesiologists could be an efficient way to provide safe airway management outside the operating room.

소아 기도 관리의 최신 지견

이정림 대한마취통증의학회 2017 Anesthesia and pain medicine Vol.12 No.3

With respect to anesthesia for pediatric patients, the most challenging component is airway management because it has been known to be the most significant cause of anesthesia-related morbidity or mortality. Recently, in the field of pediatric anesthesia, several interesting studies have been published; one study presents the incidence of complications related to difficult tracheal intubation, and the other studies have performed re-examination of the upper airway anatomy. In addition, supraglottic airway devices (SGA) are the main devices not only for securing the airway in an emergent situation but also for routine anesthetic management. Therefore, it is necessary to summarize and re-consider the results of studies on SGA for better use. This review presents an introduction to the recent progressive studies regarding pediatric airway management and it provides several considerations which have been overlooked for safe and effective use of SGA.

소방 119구급대원에 의해 시행된 전문기도관리 현황 및 법적 고찰

박시은,Park, Si-Eun 한국응급구조학회 2021 한국응급구조학회지 Vol.25 No.2

Purpose: This study aimed to analyze the data from public information disclosure about pre-hospital advanced airway management and identify the problem by considering domestic laws and guidelines. Methods: Data were collected between 2017 and 2018 and analyzed using SPSS 25.0. Then, the problems of the analysis results based on the relevant laws and practical guidelines were reviewed. Results: The review of domestic laws and practice guidelines revealed that ambulance nurses can implement supraglottic airway device only under the following three conditions: ① smart advanced life support pilot project area, ② trained to insert I-Gel, and ③ member of a special ambulance. In total, 21,574 cases of advanced airway management (endotracheal intubation: 2,428, I-Gel: 18,502, LMA : 499, KING AIRWAY: 144) were reported. In many cases, advanced airway management was performed by ambulance nurses who did not meet the above conditions, which was in violation of laws and guidelines. In addition, the prognosis of intubated patients was not followed up. Conclusion: The Korea National Fire Agency must stop all unlicensed medical practice by untrained, uneducated, and uncertified nurses and demand quality control programs for intubated patients.

Interactive effect of multi-tier response and advanced airway management on clinical outcomes after out-of-hospital cardiac arrest: a nationwide population-based observational study

Lim Hyouk Jae,Song Kyoung Jun,Shin Sang Do,Kim Ki Hong,노영선,YOON HANNA 대한응급의학회 2022 Clinical and Experimental Emergency Medicine Vol.9 No.3

Objective We hypothesized that a multi-tier response (MTR) will provide high-quality cardiopulmonary resuscitation including airway management. However, the type of tier response system and airway management will have different interactive effects resulting in varying outcomes following out-of-hospital cardiac arrest (OHCA). This study aimed to determine whether the advanced airway management method has an effect on OHCA outcomes and to compare the size of the effect across MTR types. Methods This is a retrospective population-based observational study using the Korea OHCA Registry. Airway management methods were categorized into endotracheal intubation (ETI) and supraglottic airway (SGA) groups. The tier system was categorized into single-tier response (STR) or two types of MTR: ambulance-ambulance MTR or fire engine-ambulance MTR. Results In total, 45,264 patients were analyzed among the 89,087 emergency medical service assessed OHCAs. The SGA group was significantly associated with a lower prehospital return of spontaneous circulation (ROSC) rate compared to the ETI group (adjusted odds ratio [aOR], 0.79; 95% confidence interval [CI], 0.72–0.88). Both MTR with an ambulance or fire engine were significantly associated with higher prehospital ROSC rates compared to STR (STR vs. MTR with an ambulance: aOR, 1.33; 95% CI, 1.21–1.47; STR vs. MTR with a fire engine: aOR, 1.43; 95% CI, 1.20–1.71). Prehospital SGA was significantly associated with poor neurological outcomes in MTR with fire engine (aOR, 0.71; 95% CI, 0.53–0.96). Conclusion In this nationwide observational study, we observed that MTR was associated with higher prehospital ROSC than STR. Moreover, SGA is associated with a lower prehospital ROSC rate regardless of tier response type compared to ETI.

Airway management of a patient incidentally diagnosed with Mounier-Kuhn syndrome during general anesthesia

No, Hyun-Joung,Lee, Jung-Man,Won, Dongwook,Kang, Pyoyoon,Choi, Seungeun The Korean Dental Society of Anesthsiology 2019 Journal of Dental Anesthesia and Pain Medicine Vol.19 No.5

Mounier-Kuhn syndrome (MKS) is a disease characterized by dilation of the trachea and mainstem bronchi. Due to the risk of airway leakage, pulmonary aspiration, and tracheal damage, MKS can be fatal in patients undergoing tracheal intubation. Moreover, MKS may not be diagnosed preoperatively due to its rarity. In this case, a patient undergoing neurosurgery was incidentally diagnosed with MKS during general anesthesia. During anesthesia induction, difficulties in airway management led the anesthesiologist to suspect MKS. Airway leakage was resolved in this case using oropharyngeal gauze packing. Anesthesiologists should be aware of the possibility of MKS and appropriate management of the airways.

Endotracheal intubation using a three-dimensional printed airway model in a patient with Pierre Robin sequence and a history of tracheostomy -a case report-

Park Seyeon,Ahn Jisoo,Kim Hye-Jin,Choi Eun-Ji,김희영 대한마취통증의학회 2021 Korean Journal of Anesthesiology Vol.74 No.3

Background: Pierre Robin sequence (PRS) patients have an increased risk of difficult intubation due to anatomical airway abnormalities, and intubation simulation with a three-dimensional (3D) printed airway model before anesthesia may facilitate safe airway management. Case: We describe the case of a 6.5-year-old boy with a history of PRS (a triad of micrognathia, glossoptosis, and airway obstruction), tracheostomy, and subglottic fibrosis who required general anesthesia. Preparation for this potentially difficult intubation included estimation of endotracheal tube size using a 3D printed airway model derived from 3D computed tomography of the airway, which enabled successful endotracheal intubation via video laryngoscopy.Conclusions: If general anesthesia is necessary in patients with dysmorphic features such as PRS and there is a history of tracheal pathology, the possibility of difficult intubation should always be considered and simulation of endotracheal intubation using a 3D printed model of the airway can be helpful clinically in such situations.

A Case of a Temporary Endotracheal Stent for Airway Management in a Patient with Primary Thyroid Lymphoma

김영철,여성철,김진평,박정제 대한이비인후과학회 2020 대한이비인후과학회지 두경부외과학 Vol.63 No.2

Primary thyroid lymphoma is a rare malignancy that can grow rapidly and compress the airway. In such cases, a tracheostomy or thyroidectomy is generally required. Here, we report a case of a 76-year-old woman diagnosed with primary thyroid diffuse large B-cell lymphoma (DLBL), with dyspnea attributed to tracheal compression by the enlarged thyroid. The patient’s poor general condition meant that thyroidectomy was considered challenging. Therefore, a temporary endotracheal silicone stent was successfully inserted to maintain the airway, as tracheal stenting has been shown to be an effective treatment for both benign and malignant obstructive airway diseases. We conclude that, in patients with primary thyroid DLBL who present with airway compression but are not eligible for surgery, tracheal stent insertion can maintain the airway and allow time for chemotherapy to be administered.

병원 외 심정지 환자에서 119 구급대원의 전문기도유지술 시행에 영향을 미치는 요인

서아람,김대희 사단법인 한국응급구조학회 2019 한국응급구조학회지 Vol.23 No.1

Purpose: Advanced airway maintenance improves the quality of cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients. In this study, we evaluate the factors associated with advanced airway management while performing CPR for out-of-hospital cardiac arrest patients by 119 emergency medical technicians (EMTs). Methods: The observational analysis method was used ro retrospectively collect data from 119 rescue run sheets. This study was conducted in a fire station in Seoul, Korea. The subjects of this study were defined as OHCA patients who received CPR from July 2016 to June 2018. We divided the subjects into two groups according to whether advanced airway maintenance was performed or not, and then compared and analyzed both groups. We performed logistic regression analyses for characteristics that differed significantly between groups. Results: Out of 188 OHCA patients, 146 (77.7%) had received advanced airway management. Statistically significant differences in the logistic analysis were found regarding the total number of EMT professionals (adjusted odds ration [aOR]: 1.955; 95% confidence interval [CI]: 1.227-3.115; p=0.005) and scene-time (aOR:1.119;95%CI:1.019-1.228;p=0.019). Conclusion: Advanced airway maintenance while performing CPR for OHCA patients by EMT associated primarily with ensuring an adequate numbers of EMT professionals and sufficient scene time.