Considerazioni sulla gestione delle vie aeree in ACR

27 Set

L’intubazione orotracheale è un’opzione ancora valida in corso di ACR?
Interrompere la RCP per per posizionare un tubo orotracheale è una manovra che ha dimostrato dei vantaggi sugli end point classici dell’ACR: mortalità e outcome neurologico alla dimissione?
Cosa dice la letteratura recente su questi quesiti?

  • Una review di Cochrane del 2009 ha individuato tre lavori RC che non dimostrano alcun beneficio significativo della IOT rispetto ai presidi sopraglottici ed alla ventilazione a maschera rispetto agli end points primari.

Cochrane Emergency intubation for acutely ill and injured patients

  • Uno studio di coorte su popolazione effettuato in Corea non dimostra differenza sugli end points primari

Out-of-hospital airway management and cardiac arrest outcomes

  • Un recente articolo pubblicato su Resuscitation nel 2012 dimostra invece che i pazienti intubati sul campo hanno un miglior outcome neurologico

Endotracheal intubation versus supraglottic airway insertion in OHCA

  • Sicuramente il target di ventilazione e ossigenazione di un paziente critico è la normossia.

SpO2 targets—How normal is normal?  

SpO2 values in acute medical admissions breathing air—Implications for the British Thoracic Society guideline for emergency oxygen use in adult patients?

  • E’ sicuramente dannosa l’iperossia

Association Between Arterial Hyperoxia Following Resuscitation From Cardiac Arrest and In-Hospital Mortality 

La mia opinione dopo la considerazione della letteratura:

  • Gestione avanzata delle vie aeree mediante IOT solo da parte di personale sanitario esperto, secondo protocollo vigente e con interruzione minima della RCP.
  • Tutti gli altri professionisti sanitari devono utilizzare presidi sopvraglottici o ventilazione a maschera, prediligendo delle due quella con cui hanno più dimistichezza, e valutare la migliore strategia per un precoce contatto con personale esperto.
  • Controllo capnografico della ventilazione e saturimetrico dell’ossigenazione periferica, qualsiasi sia l’approccio adottato, per ottenere la normossia (intesa come parametri di EtCO2 e SpO2 normali) ed evitare l’iperossia.

Capnography during cardiopulmonary resuscitation

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