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Abstract
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We appreciate the efforts of Dr. Yoshimura et al1
in examining potential benefits of endotracheal tube placement(ETT) versus supraglottic airway device(SGA) in the treatment of drowning victims. Airway intervention in drowning is critical since cardiopulmonary arrest in this scenario is due to systemic hypoxemia, in contrast to acute myocardial ischemia which may present with cardiac arrest due to ventricular fibrillation. In drowning, ETT as compared to SGA potentially has a number of benefits: (1) more secure airway less likely to dislodge during rescue, CPR and transport to the hospital, (2) ability to administer higher pressure breaths which may be necessary if lung compliance is altered due to water aspiration and/or laryngo-bronchospasm, (3) ventilation through ETT doesn't insufflate the stomach, (4) the cuffed ETT provides protection against additional aspiration, the risk of which is increased due to likely water ingestion, and (5) ETT allows access to decompress the stomach with a gastric tube. The primary advantages of the SGA are that it is far easier to place and may be more readily available to lifeguards because it requires a lower level of training for use, while its disadvantages include its propensity to being dislodged and inability to deliver high pressure breaths. Pressures breaching the SGA seal are likely to increase abdominal distension and thereby increase risk of emesis and aspiration. Detecting a breached seal may also be difficult in the loud and often chaotic environment of rescue and transport to the hospital. Yoshimura et al note that SGA failure in drowning was first reported in 2011, appreciating that lung compliance may rapidly decrease by 66% in just minutes with small volumes of sea water aspiration in animal models.2
It is likely that these reasons may contribute to the improved ROSC rate with ETT in this study, which is consistent with the only other study examining ETT vs SGA in drowning.3...
Language: en |