Scientific and Technological Research
Evaluating supraglottic airway laryngopharyngeal tube as a practical device for blind endotracheal intubation by non-experienced personnel in dummies
Evaluación del tubo laringofaríngeo supraglótico como un dispositivo útil para intubación endotraqueal a ciegas, en personal no experimentado, utilizando maniquíes
Hellen Carolina Uribe-Valenciaa,
, Iván Darío Arenas Correab, Jorge Luis Apellido Reyesc
Corresponding author
carolinaurival@gmail.com
Corresponding author at: Calle 146 # 12A – 40 Ap. 402, Bogotá, D.C, 300 7822585, Colombia.
Corresponding author at: Calle 146 # 12A – 40 Ap. 402, Bogotá, D.C, 300 7822585, Colombia.
a MD, Residente Medicina de Urgencias, Universidad de Antioquia, Investigador principal, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
b MD, Anestesiólogo Grupo de Trasplantes IPS Universitaria, Universidad de Antioquia, Anestesiólogo IATM, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
c MD, Magister en Ciencias Clínicas, Profesor del Departamento de Salud Pública, Universidad del Norte, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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array:3 [ "nombre" => "Jorge Luis Apellido" "apellidos" => "Reyes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "MD, Residente Medicina de Urgencias, Universidad de Antioquia, Investigador principal, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "MD, Anestesiólogo Grupo de Trasplantes IPS Universitaria, Universidad de Antioquia, Anestesiólogo IATM, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "MD, Magister en Ciencias Clínicas, Profesor del Departamento de Salud Pública, Universidad del Norte, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author at</span>: Calle 146 # 12A – 40 Ap. 402, Bogotá, D.C, 300 7822585, Colombia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación del tubo laringofaríngeo supraglótico como un dispositivo útil para intubación endotraqueal a ciegas, en personal no experimentado, utilizando maniquíes" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source:</span> Taken at the simulation room by the research team. University of Antioquia." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 697 "Ancho" => 1650 "Tamanyo" => 176819 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">SALT Device (Supraglottic Laryngopharyngeal Tube).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In Colombia, pre-hospital and disaster medicine is an emerging and growing area that has evolved toward adequate patient care outside the hospital environment. This is where emergency care is initially administered that may impact the risk of death or of undesirable sequelae if the patient survives. One of the cornerstones of pre-hospital care is airway control. Direct laryngoscopy (DL) Orotracheal intubation (OTI) is the gold standard for airway management (AW).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Supraglottic devices are the second best treatment choice when emergency OTI is not available; consequently, the best options for a pre-hospital situation shall be carefully studied.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The SALT (Supraglottic Airway Laryngopharyngeal Tube<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> (see <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) is a new supraglottic device that enables the insertion of a 6.5- to 9.0-mm endotracheal tube (ETT). The device may be left in place for 6<span class="elsevierStyleHsp" style=""></span>h or may be removed upon verification of a correct intubation. On May 2005 the FDA approved the device for human use as a Class I device, but in our country it has not yet been approved.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Considering that the anatomic characteristics of the airway dimensions differ depending on the geographical population, the intended research is aimed initially at determining blind intubation success rate by unskilled personnel in a simulated environment.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a descriptive simulation trial using dummies, at the Universidad de Antioquia simulation center. The participants were medical students, 18 years old and above, first aid personnel from the army who attended training courses and pre-hospital care (PHC) at the simulation center. The participants with previous advanced airway management training and instructors of cardiopulmonary resuscitation were excluded. The sample size was 90 participants and the dummies used were: Laerdal: Resusci-Anne. A standard lubricated 7.5<span class="elsevierStyleHsp" style=""></span>mm was used.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The participants received a 20-min training on the proper use of the device at the simulation room. Then each participant intubated the dummy. The time elapsed from the moment the device was delivered and the ETT insertion at every attempt was recorded in seconds. The stop watch began at zero seconds and the final time was the ETT insertion time.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Following each attempt to position the SALT and potential intubation, the researcher checked for proper intubation using direct laryngoscopy. In case of failed intubation defined as the malpositioning of ETT in the airway (trachea), the device was given back to the participant for a second attempt. Each participant was allowed a maximum of three attempts.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The ethics committee approved the research and each participant had to sign an informed consent prior to admission to the trial.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The variables measured included ETT insertion, successful intubation in three attempts, level of difficulty perceived for the intubation using a Linkert-type scale and the number of attempts required for a successful intubation. The SPSS version 20 statistical software was used for the analysis of the results.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">A total of 90 participants were recruited as per the protocol. In the course of the trial, inexperienced staff from different areas were included (Pre-Hospital Care, military personnel, medical students). The age range of the participants was 19–51 years distributed as follows: 10–25 years, 58.9%, and more than 25 years, 41.1%.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Of the participants 96.7% considered that using SALT was easy (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) and 90% accomplished a successful intubation at the first attempt (see <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Only one failed intubation event was recorded – 1.1% of the participants.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The mean time required for blind intubation during the first attempt was 16<span class="elsevierStyleHsp" style=""></span>s (inter-quartile range 13–20<span class="elsevierStyleHsp" style=""></span>s) (see <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Optimum airway (AW) and ventilation management of critical patients is a cornerstone for the patient's survival, evolution and prognosis, particularly in a pre-hospital setting and in the ER.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Direct laryngoscopy OTI requires training of at least 50 successful attempts to achieve more than 90% success rate, in addition to regular practice to keep up that level of performance.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">It has been shown that OTI in the pre-hospital setting is possible when experienced personnel control the AW; there are several factors affecting the outcome including blood, vomiting and secretions, as well as anatomical variations, the patient's position, and environmental factors.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The difficulty lies in the additional practice required to maintain the orotracheal intubation skills that sometimes may not be enough<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and may require further emphasis on the proper use of the Bag Mask Valve (BMV) or adequate handling of the supraglottic devices (SD).</p><p id="par0085" class="elsevierStylePara elsevierViewall">The use of the BMV in a pre-hospital setting allows for effective ventilation with satisfactory neurological outcomes in patients with return or spontaneous circulation (ROSC) and may even be better than an advanced airway attempt;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> however, keeping it for long periods of time may prove to be difficult, particularly when the patient is transferred in an ambulance; a safe AW should be secured for transfer.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Supraglottic devices for AW management are the second treatment option to secure the airway if intubation fails; however, these devices do not completely isolate the airway from the GI tract and there is a risk of bronchoaspiration, particularly in emergency situations when the assumption is that the patient has a full stomach.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Supraglottic devices to secure a safe advanced airway could be the option as a pre-hospital approach for a considerable number of patients.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Thus we researched SALT based on its characteristics and advantages as compared to other devices (easy-to-use design, minimum learning curve for blind intubation, suggested for difficult settings, use of conventional ETTs, and lower cost versus that of the devices available in the market (25 US$ in contrast to US$250 for a regular multiple use laryngeal mask (ILMA) and $70 for the single use and disposable mask).</p><p id="par0100" class="elsevierStylePara elsevierViewall">The first consideration is SALT's effectiveness for securing an advanced airway with a high percentage of successful procedures in the first attempt, in contrast with the previous SALT trial that resulted in a first attempt success rate of 66.4%.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This is a critical finding considering that the airway has to be secured in patients undergoing resuscitation or ROSC, who will have a long transfer time or when BMV ventilation is difficult, to contribute to a better outcome, both in terms of morbidity and mortality.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The time to introduction and intubation is short, considering that non-trained personnel may take 69<span class="elsevierStyleHsp" style=""></span>s using the ILMA, (CI 95% 51–88) in their first attempt, without OTI,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> which is longer than with SALT and fail to secure an advance AW. This time may be influenced by the easy maneuver with SALT or by the lower risk perception when intubating a dummy.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The training time needed for the device was short, suggesting the SALT's learning curve is short, in addition to the fact that the introduction and intubation were considered easy, hence facilitating the training process of the Pre-Hospital Care staff in the proper use of the device.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The heterogeneity of the population associated with the percentage of intubations, may indicate that even people with minimal health care knowledge may be able to properly use the device.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The major limitation of the trial is the use of dummies; however, this allows for a strict standardization of the trial conditions; nevertheless, the data should be confirmed in a real life scenario.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Comparisons have been made against the results from using supraglottic devices in dummies in a clinical setting, and the results suggest that the use of dummies is comparable.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">It should be noted that this device should be tested in humans (initially in cadavers) against other SDs because the anatomic characteristics of the larynx vary from patient to patient. The SALT was evaluated in cadavers in a Pre-Hospital setting with a 91% success rate (confidence interval CI 95%: 71–99) with a percentage intubation of 59% (CI 95%: 36–79) at first attempt,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> which was low versus our trial results. However, the same cadaver was used several times and this predisposes to a margin of error since the tissues must be intact to verify the effectiveness of the device.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0130" class="elsevierStylePara elsevierViewall">The SALT is a simple and effective device that results in a high rate of successful first attempt blind intubation. The instructions for use of the SALT are easy to follow by non-skilled personnel and the mean time to complete the procedure is shorter than with other supraglottic devices.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Additional trials shall be conducted in our environment in humans to verify the real life effectiveness of the device, since the characteristics of the larynx may change from patient to patient. SALT's effectiveness has been demonstrated only in a simulated environment.</p><p id="par0140" class="elsevierStylePara elsevierViewall">SALT may become a device for AW management by unskilled personnel or a second choice device for difficult airways.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">Authors’ resources.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres354041" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Objective" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec335381" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres354042" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Objetivo" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec335380" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methodology" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-10-02" "fechaAceptado" => "2014-03-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec335381" "palabras" => array:5 [ 0 => "Endotracheal intubation" 1 => "Pre-hospital care" 2 => "Emergency medical services" 3 => "Dummies" 4 => "Simulation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec335380" "palabras" => array:5 [ 0 => "Intubación endotraqueal" 1 => "Atención prehospitalaria" 2 => "Servicios médicos de urgencias" 3 => "Maniquíes" 4 => "Simulación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">One of the key objectives in the pre-hospital environment is to control and secure the airway. Supraglottic airway laryngopharyngeal tube (SALT) is a basic device designed to ventilate and guide the blind introduction of the endotracheal tube. It has not yet been approved in our environment.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To determine the blind intubation success rate of non-trained personnel.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A descriptive trial with 90 participants in a simulated environment with dummies. In 96.7% of the cases, the intubation procedure with the device was perceived as easy. In all, 90% had a successful intubation in the first attempt in 16<span class="elsevierStyleHsp" style=""></span>s, which is a shorter time period as compared to intubation with other devices.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">SALT could be an effective airway management device for non-trained individuals.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En el ambiente prehospitalario, un objetivo fundamental es el control y aseguramiento de la vía aérea. El tubo laringofaríngeo supraglótico (SALT, por sus siglas en inglés) fue diseñado como dispositivo básico para ventilación y como introductor de TET para intubación a ciegas, aún no aprobado en nuestro medio.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Determinar la tasa de éxito de intubación a ciegas en personal no entrenado.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo, con 90 participantes en medio ambiente simulado con maniquíes. Se observó que el grado de dificultad percibida al intubar con el dispositivo fue fácil en el 96,7%. El 90% intubaron de manera exitosa en el primer intento, con un tiempo de intubación en el primer intento de 16<span class="elsevierStyleHsp" style=""></span>s, corto respecto a otros dispositivos.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El SALT es un dispositivo que podría ser una opción efectiva para asumir la vía aérea en personal no entrenado.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Uribe-Valencia HC, Correa IDA, Reyes JLA, Venue T. Evaluación del tubo laringofaríngeo supraglótico como un dispositivo útil para intubación endotraqueal a ciegas, en personal no experimentado, utilizando maniquíes. Rev Colomb Anestesiol. 2014;42:172–175.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source:</span> Taken at the simulation room by the research team. University of Antioquia." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 697 "Ancho" => 1650 "Tamanyo" => 176819 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">SALT Device (Supraglottic Laryngopharyngeal Tube).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Author." "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">SALT: Supraglottic Airway Laryngopharyngeal Tube.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Perception \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Frequency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Percentage \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Very easy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Easy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not easy, nor difficult \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Difficult \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Very difficult \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab528995.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Difficulty to intubate with SALT as perceived by the participants.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Author." "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Attempts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Frequency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Percentage<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">One \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Two \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Three \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab528994.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">One of the participants failed to succeed after 3 attempts.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Number of attempts needed for a successful intubation.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Author." "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">NA: not applicable.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>: Tables 1, 2 and 3: Data collection and analysis during the course of the research: Evaluating SALT as a practical device for blind endotracheal intubation by non-experienced personnel in dummies.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Interquartile range \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First attempt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13–20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Second attempt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18–25.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Third attempt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab528993.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Average Time in seconds to a successful intubation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manejo prehospitalario de la vía aérea. 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Lange" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2044.2008.05812.x" "Revista" => array:6 [ "tituloSerie" => "Anaesthesia" "fecha" => "2009" "volumen" => "64" "paginaInicial" => "549" "paginaFinal" => "554" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19413826" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of paramedic utilization of the Intubating Laryngeal Mask Airway in high-fidelity simulated critical care scenarios" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Byars" 1 => "B. Lo" 2 => "J. Yates" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S1049023X12001628" "Revista" => array:6 [ "tituloSerie" => "Prehosp Disaster Med" "fecha" => "2013" "volumen" => "28" "paginaInicial" => "1" "paginaFinal" => "2" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23158909" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tracheal intubation through the I-gel TM supraglottic airway versus the LMA Fastrach TM: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Halwagi" 1 => "N. Massicotte" 2 => "A. Lallo" 3 => "A. Gauthier" 4 => "D. Boudreault" 5 => "M. Ruel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e318236f438" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2012" "volumen" => "114" "paginaInicial" => "152" "paginaFinal" => "156" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22075016" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can emergency medical services personnel effectively place and use the Supraglottic Airway Laryngopharyngeal Tube (SALT) airway?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Bledsoe" 1 => "D. Slattery" 2 => "R. Lauver" 3 => "W. Forred" 4 => "L. Johnson" 5 => "G. Rigo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/10903127.2011.561410" "Revista" => array:6 [ "tituloSerie" => "Prehosp Emerg Care" "fecha" => "2011" "volumen" => "15" "paginaInicial" => "359" "paginaFinal" => "365" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21521038" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22562087/0000004200000003/v2_201407220045/S2256208714000479/v2_201407220045/en/main.assets" "Apartado" => array:4 [ "identificador" => "951" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific and Technological Research" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22562087/0000004200000003/v2_201407220045/S2256208714000479/v2_201407220045/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208714000479?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 1 | 12 |
| 2024 October | 41 | 4 | 45 |
| 2024 September | 45 | 3 | 48 |
| 2024 August | 49 | 7 | 56 |
| 2024 July | 45 | 1 | 46 |
| 2024 June | 36 | 4 | 40 |
| 2024 May | 47 | 3 | 50 |
| 2024 April | 27 | 9 | 36 |
| 2024 March | 59 | 6 | 65 |
| 2024 February | 53 | 8 | 61 |
| 2024 January | 33 | 7 | 40 |
| 2023 December | 39 | 3 | 42 |
| 2023 November | 45 | 10 | 55 |
| 2023 October | 76 | 17 | 93 |
| 2023 September | 51 | 15 | 66 |
| 2023 August | 45 | 3 | 48 |
| 2023 July | 57 | 7 | 64 |
| 2023 June | 52 | 1 | 53 |
| 2023 May | 99 | 4 | 103 |
| 2023 April | 68 | 1 | 69 |
| 2023 March | 53 | 3 | 56 |
| 2023 February | 47 | 14 | 61 |
| 2023 January | 27 | 5 | 32 |
| 2022 December | 36 | 7 | 43 |
| 2022 November | 21 | 8 | 29 |
| 2022 October | 32 | 11 | 43 |
| 2022 September | 26 | 18 | 44 |
| 2022 August | 22 | 15 | 37 |
| 2022 July | 17 | 8 | 25 |
| 2022 June | 41 | 4 | 45 |
| 2022 May | 40 | 4 | 44 |
| 2022 April | 34 | 8 | 42 |
| 2022 March | 33 | 8 | 41 |
| 2022 February | 9 | 5 | 14 |
| 2022 January | 13 | 4 | 17 |
| 2021 December | 12 | 8 | 20 |
| 2021 November | 6 | 8 | 14 |
| 2021 October | 22 | 8 | 30 |
| 2021 September | 9 | 7 | 16 |
| 2021 August | 21 | 9 | 30 |
| 2021 July | 9 | 2 | 11 |
| 2021 June | 7 | 6 | 13 |
| 2021 May | 9 | 6 | 15 |
| 2021 April | 34 | 10 | 44 |
| 2021 March | 26 | 5 | 31 |
| 2021 February | 7 | 6 | 13 |
| 2021 January | 3 | 6 | 9 |
| 2020 December | 9 | 8 | 17 |
| 2020 November | 7 | 7 | 14 |
| 2020 October | 3 | 4 | 7 |
| 2020 September | 6 | 6 | 12 |
| 2020 August | 9 | 10 | 19 |
| 2020 July | 8 | 5 | 13 |
| 2020 June | 2 | 1 | 3 |
| 2020 May | 6 | 5 | 11 |
| 2020 April | 4 | 3 | 7 |
| 2020 March | 2 | 0 | 2 |
| 2020 February | 5 | 3 | 8 |
| 2020 January | 5 | 3 | 8 |
| 2019 December | 5 | 11 | 16 |
| 2019 November | 0 | 2 | 2 |
| 2019 October | 2 | 6 | 8 |
| 2019 September | 1 | 5 | 6 |
| 2019 August | 1 | 2 | 3 |
| 2019 July | 1 | 4 | 5 |
| 2019 June | 0 | 7 | 7 |
| 2019 May | 1 | 12 | 13 |
| 2019 April | 0 | 1 | 1 |
| 2018 December | 0 | 1 | 1 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 1 | 1 | 2 |
| 2018 August | 0 | 3 | 3 |
| 2018 July | 0 | 1 | 1 |
| 2018 June | 5 | 3 | 8 |
| 2018 May | 26 | 6 | 32 |
| 2018 April | 30 | 6 | 36 |
| 2018 March | 33 | 9 | 42 |
| 2018 February | 19 | 11 | 30 |
| 2018 January | 23 | 8 | 31 |
| 2017 December | 34 | 9 | 43 |
| 2017 November | 26 | 8 | 34 |
| 2017 October | 42 | 5 | 47 |
| 2017 September | 45 | 8 | 53 |
| 2017 August | 50 | 9 | 59 |
| 2017 July | 49 | 20 | 69 |
| 2017 June | 70 | 22 | 92 |
| 2017 May | 59 | 14 | 73 |
| 2017 April | 57 | 13 | 70 |
| 2017 March | 36 | 32 | 68 |
| 2017 February | 39 | 14 | 53 |
| 2017 January | 27 | 10 | 37 |
| 2016 December | 47 | 10 | 57 |
| 2016 November | 43 | 9 | 52 |
| 2016 October | 86 | 8 | 94 |
| 2016 September | 117 | 14 | 131 |
| 2016 August | 71 | 12 | 83 |
| 2016 July | 29 | 6 | 35 |
| 2016 June | 0 | 17 | 17 |
| 2016 May | 4 | 16 | 20 |
| 2016 March | 1 | 21 | 22 |
| 2016 February | 0 | 17 | 17 |
| 2016 January | 0 | 13 | 13 |
| 2015 December | 25 | 16 | 41 |
| 2015 November | 94 | 14 | 108 |
| 2015 October | 86 | 7 | 93 |
| 2015 September | 68 | 9 | 77 |
| 2015 August | 91 | 8 | 99 |
| 2015 July | 71 | 7 | 78 |
| 2015 June | 43 | 9 | 52 |
| 2015 May | 53 | 8 | 61 |
| 2015 April | 43 | 4 | 47 |
| 2015 March | 55 | 11 | 66 |
| 2015 February | 75 | 10 | 85 |
| 2015 January | 66 | 6 | 72 |
| 2014 December | 64 | 15 | 79 |
| 2014 November | 55 | 8 | 63 |
| 2014 October | 80 | 13 | 93 |
| 2014 September | 89 | 14 | 103 |
| 2014 August | 58 | 13 | 71 |
| 2014 July | 68 | 16 | 84 |
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