Use of checklists improves the quality and safety of prehospital emergency care.

Objectives: High-level emergency medical care requires transfer of evidence-based knowledge into practice. Our study is the first to investigate the feasibility of checklists in improving prehospital emergency care.

Materials And Methods: Three checklists based on standard operating procedures were introduced: General principles of prehospital care, acute coronary syndrome and acute asthma/acutely exacerbated chronic obstructive pulmonary disease.

Influence of an impedance threshold valve on ventilation with supraglottic airway devices during cardiopulmonary resuscitation in a manikin.

Aim: This study investigates if a n impedance threshold valve (ITV) might improve survival after cardiac arrest by increasing vital organ blood flow. The combination of ITV and supraglottic airway devices (SADs) has not been previously studied. This simulation study in a manikin aimed at analysing differences in ventilation with different SADs without and with an ITV.

Helicopter emergency medical services accident rates in different international air rescue systems.

Aim: Each year approximately two to four helicopter emergency medical services (HEMS) crashes occur in Germany. The aim of the present study was to compare crash rates and fatal crash rates in Germany to rates in other countries.

Materials And Methods: A MEDLINE search from 1970 to 2009 was performed using combinations of the keywords "HEMS", "rescue helicopter", "accident", "accident rate", "crash", and "crash rate".

Laryngeal tube and intubating laryngeal mask insertion in a manikin by first-responder trainees after a short video-clip demonstration.

Introduction: This study was performed in the Finnish Defense Forces to assess the potential applicability and value of short video clips as educational material to teach advanced airway management and as the first means of introducing the use of a laryngeal tube (LT) or an intubating laryngeal mask (ILMA) to inexperienced, military, first-responder trainees with no prior hands-on experience.

Methods: The 60 non-commissioned medical officers participating in this study were randomly assigned into one of two groups: the LT- and the ILMA-group. After viewing the video clips, the trainees were required to perform 10 consecutive, successful insertions of the given instrument into a manikin.

Prospective randomized comparison of the new Laryngeal Tube Suction LTS II and the LMA-ProSeal for elective surgical interventions.

Background And Aim: The Laryngeal Tube Suction (LTS) has recently undergone considerable changes in design. The new LTS II was compared with the LMA-ProSeal to determine device performance during general anaesthesia and controlled ventilation.

Methods: After Institutional Review Board approval, 100 elective surgical patients were randomized to be ventilated with LTS II or LMA-ProSeal.

Artificial acrylic finger nails may alter pulse oximetry measurement.

Introduction: Pulse oximetry is the most common technique to monitor oxygen saturation (SpO(2)) during intensive care therapy. However, intermittent co-oximetry is still the "gold standard" (SaO(2)). Besides acrylic nails, numerous other factors have been reported to interfere with pulse oximetry.

Perforation of the left atrium by a chest tube in a patient with cardiomegaly: management of a rare, but life-threatening complication.

Perforation of the heart is a rare, but life-threatening complication of chest tube thoracostomy. We report the very unusual case where right-sided insertion of a Matthys catheter (6 F) due to pleural effusion resulted in a left atrium perforation. Heart injury was immediately considered as a continuous flow of bright red blood emerging through the chest drain.

Prospective, randomized comparison of laryngeal tube and laryngeal mask airway in pediatric patients.

Background: While reports of the use of laryngeal mask airway (LMA)-Classic in great patient numbers are available, data on the use of the laryngeal tube (LT) in this age group is limited. The two devices are compared in a prospective randomized trial to evaluate success rates and quality of airway seal.

Methods: Sixty children, aged 2-8 years, scheduled for elective surgical interventions were randomized to be ventilated with LMA or LT.

Effect of nail polish on oxygen saturation determined by pulse oximetry in critically ill patients.

Introduction: Nail polish of different colours may alter accuracy and precision of pulse oximetry as previous data in healthy volunteers suggest. This trial evaluates the oxygen saturation determined by pulse oximetry and haematoximetry with nail polish of nine different colours applied.

Material And Methods: Fifty critically ill and mechanically ventilated patients in an ICU were investigated in a prospective clinical-experimental trial.

Oxygen delivery comparison of two constant-flow masks during flight to 6863 m.

Objective: Differences in mask design may alter the oxygen flow required to gain similar oxygenation at a particular altitude. The selection of the most efficient mask would be advantageous for general aviation and other applications where oxygen supply is limited.

Methods: We compared a basic mask (BAS) without valves or oxygen reservoir bag to a test mask (TST) with three valves and a reservoir designed to deliver up to 80% oxygen for critically ill patients.

Perioperative risks and their management in patients with sleep-related breathing disorders.

Patients with sleep apnea syndromes pose several challenges to the anaesthetist. These are resulting from comorbidity, but mainly from special requirements for pre-, intra- and postoperative management.Frequently, the diagnosis is not known or not diagnosed adequately, making careful preoperative evaluation of the patient by the anaesthetist imperative to identify patients at risk.

A multicenter study of the Ambu laryngeal mask in nonparalyzed, anesthetized patients.

We designed this multicenter trial to evaluate the performance and safety of the Ambu laryngeal mask, a new disposable supraglottic airway device, in patients scheduled for elective surgery. One-hundred-eighteen nonparalyzed, anesthetized patients (ASA physical status I-II, age, 18-65 yr, body mass index, 18-30 kg/m(-2)) receiving total IV anesthesia were included in this study. After device insertion, fiberoptic position and oropharyngeal leak pressure were determined at an intracuff pressure of 60 cm H2O.

Airway management with the Laryngeal Tube Suction II in a patient with cervical spine injury.

Supraglottic airway devices may offer alternative strategies for securing the airway in patients with cervical spine injuries. A case of airway management with the LTS II, a modified version of the laryngeal tube suction, in a patient with a paramedian atlas fracture scheduled for decompression of a haematoma on the forehead is described. Device insertion was successful in the first attempt and a gastric tube was inserted without problems.

Ventilation with the laryngeal tube in pediatric patients undergoing elective ambulatory surgery.

Background: The laryngeal tube is a new supraglottic alternative for securing the airway. Few data on the use of this airway device in pediatric patients are so far available. Experiences of the study are reported.

The ProSeal laryngeal mask airway and the laryngeal tube Suction for ventilation in gynaecological patients undergoing laparoscopic surgery.

Background And Objective: ProSeal Laryngeal Mask Airway (PLMA) and Laryngeal Tube Suction (LTS), supraglottic airway devices allowing gastric drainage, were compared in this prospective, randomized study for airway management under conditions with elevated intra-abdominal pressure induced by capnoperitoneum.

Methods: Fifty patients undergoing elective gynaecological laparoscopic surgery were randomized to two groups of 25 each. After induction of general anaesthesia, devices were inserted, correct placement was verified, airway leak pressure was measured, and a gastric tube was inserted.

Detection of a systolic pressure threshold for reliable readings in pulse oximetry.

Objective: To determine the error of measurement in pulse oximetry with a decreased arterial perfusion and to identify a systolic pressure threshold for (1) initial detection and (2) a reliable reading of oxygen saturation.

Design: An experimental clinical prospective study. The study was approved by the local ethics committee.

Fibreoptic tracheal intubation after placement of the laryngeal tube.

Background: The laryngeal tube is a new alternative for securing the airway. After adequate oxygenation, insertion of a tracheal tube is still required in many situations. In such circumstances, fibreoptic placement of a tube exchange catheter after placement of the laryngeal tube is possible before tracheal intubation.