AHA-ACLS2010年版ガイドラインにおける気道管理と間接声門視認型喉頭鏡エアウェイスコープの可能性

AHA2010年度版ACLSガイドラインは，2005年度版に比してさらなる胸骨圧迫の質を強調している．心肺蘇生中に胸骨圧迫の中断なく気管挿管ができれば，(1)連続的な胸骨圧迫，(2)効率的な肺を通した脳および心臓の酸素化，(3)気道保護による誤嚥防止，(4)カプノグラフィーによる蘇生の質の評価，が可能になり蘇生率の向上につながると考えられる．本稿では，間接声門視認型喉頭鏡であるエアウェイスコープの心肺蘇生時の気道確保における可能性について紹介する．...

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Published in日本臨床麻酔学会誌 Vol. 33; no. 1; pp. 117 - 123
Main Authors 駒澤, 伸泰, 植木, 隆介, 上農, 喜朗
Format Journal Article
LanguageJapanese
Published 日本臨床麻酔学会 2013
Subjects
シミュレーション
二次救命処置
困難気道
気管挿管
間接声門視認型喉頭鏡
Online AccessGet full text
ISSN0285-4945
1349-9149
DOI10.2199/jjsca.33.117

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Abstract AHA2010年度版ACLSガイドラインは，2005年度版に比してさらなる胸骨圧迫の質を強調している．心肺蘇生中に胸骨圧迫の中断なく気管挿管ができれば，(1)連続的な胸骨圧迫，(2)効率的な肺を通した脳および心臓の酸素化，(3)気道保護による誤嚥防止，(4)カプノグラフィーによる蘇生の質の評価，が可能になり蘇生率の向上につながると考えられる．本稿では，間接声門視認型喉頭鏡であるエアウェイスコープの心肺蘇生時の気道確保における可能性について紹介する．
AbstractList [要旨] AHA2010年度版ACLSガイドラインは, 2005年度版に比してさらなる胸骨圧迫の質を強調している. 心肺蘇生中に胸骨圧迫の中断なく気管挿管ができれば, (1)連続的な胸骨圧迫, (2)効率的な肺を通した脳および心臓の酸素化, (3)気道保護による誤嚥防止, (4)カプノグラフィーによる蘇生の質の評価, が可能になり蘇生率の向上につながると考えられる. 本稿では, 間接声門視認型喉頭鏡であるエアウェイスコープの心肺蘇生時の気道確保における可能性について紹介する. 「はじめに」AHA2010年度版二次救命処置(ACLS)ガイドラインは, 2005年度版以上に胸骨圧迫の質を強調している. 一方, 気道管理に関しては, 非熟練者にはバッグマスク換気や声門上デバイスを推奨し, 気管挿管は熟練者のみに推奨されるとしている1),2). 心肺蘇生は手術室のベッドのように気道確保に最適な環境ではなく, 床上や屋外, 仰臥位以外の体位でも起こりうる.
AHA2010年度版ACLSガイドラインは，2005年度版に比してさらなる胸骨圧迫の質を強調している．心肺蘇生中に胸骨圧迫の中断なく気管挿管ができれば，(1)連続的な胸骨圧迫，(2)効率的な肺を通した脳および心臓の酸素化，(3)気道保護による誤嚥防止，(4)カプノグラフィーによる蘇生の質の評価，が可能になり蘇生率の向上につながると考えられる．本稿では，間接声門視認型喉頭鏡であるエアウェイスコープの心肺蘇生時の気道確保における可能性について紹介する．
Author 駒澤, 伸泰
上農, 喜朗
植木, 隆介
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References 11) Shy BD, Rea TD, Becker LJ, et al.: Time to intubation and survival in prehospital cardiac arrest. Prehosp Emerg Care 8: 394-399, 2004
30) 浅井隆：エアウェイスコープの現状と未来─マッキントッシュ喉頭鏡は今や無用の長物か？─．日臨麻会誌 30：611-618，2010
18) Komasawa N, Ueki R, Itani M, et al.: Evaluation of tracheal intubation in several positions by the Pentax-AWS Airway Scope: a manikin study. J Anesth 24: 908-912, 2010
15) Suzuki A, Kunisawa T, Takahata O, et al.: Pentax-AWS( Airway Scope) for awake tracheal intubation. J Clin Anesth 19: 642-643, 2007
4) Asai T, Liu EH, Matsumoto S, et al.: Use of the Pentax-AWS in 293 patients with difficult airways. Anesthesiology 110: 898-904, 2009
28) Komasawa N, Ueki R, Kohama H, et al.: Comparison of Pentax-AWS Airwayscope video laryngoscope, Airtraq optic laryngoscope, and Macintosh laryngoscope during cardiopulmonary resuscitation under cervical stabilization: a manikin study. J Anesth 25: 898-903, 2011
25) Han SK, Shin DH, Choi PC: Utility of the Pentax-AWS without interruption of chest compression: comparison of the Macintosh laryngoscope with the Pentax-AWS in manikin model. Resuscitation 81: 69-73, 2010
17) Koyama Y, Nishihama M, Inagawa G, et al.: Comparison of haemodynamic responses to tracheal intubation using the Airway Scope® and Macintosh laryngoscope in normotensive and hypertensive patients. Anaesthesia 66: 895-900, 2011
2) Neumar RW, Otto CW, Link MS, et al.: Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122 (Suppl 3): S729-S767, 2010
10) Katz SH, Falk JL: Misplaced endotracheal tubes by paramedics in an urban emergency medical services system. Ann Emerg Med 37: 32-37, 2001
3) Koyama J, Aoyama T, Kusano Y, et al.: Description and first clinical application of AirWay Scope for tracheal intubation. J Neurosurg Anesthesiol 18: 247-250, 2006
19) Asai T: Tracheal intubation with restricted access: a randomised comparison of the Pentax-Airway Scope and Macintosh laryngoscope in a manikin. Anaesthesia 64: 1114-1117, 2009
29) Shin DH, Choi PC, Han SK: Tracheal intubation during chest compressions using Pentax-AWS®, GlideScope®, and Macintosh laryngoscope: a randomized crossover trial using a mannequin. Can J Anaesth 58: 733-739, 2011
13) Takenaka I, Aoyama K, Iwagaki T, et al.: Approach combining the airway scope and the bougie for minimizing movement of the cervical spine during endotracheal intubation. Anesthesiology 110: 1335-1340, 2009
20) Takenaka I, Aoyama K, Iwagaki T, et al.: Efficacy of the Airway Scope on tracheal intubation in the lateral position: comparison with the Macintosh laryngoscope. Eur J Anaesthesiol 28: 164-168, 2011
21) Sadamori T, Kusunoki S, Ishida M, et al.: Video laryngoscopy for emergency tracheal intubation during chest compression. Resuscitation 77: 155-156, 2008
22) Sanuki T, Sugioka S, Hirokane M, et al.: Airway scope-assisted intubation during cardiopulmonary resuscitation without interruption of chest compression: the influence of chest compression rates. Resuscitation 82: 363-364, 2011
6) Wang HE, Simeone SJ, Weaver MD, et al.: Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation. Ann Emerg Med 54: 645-652, 2009
9) Jones JH, Murphy MP, Dickson RL, et al.: Emergency physician-verified out-of-hospital intubation: miss rates by paramedics. Acad Emerg Med 11: 707-709, 2004
27) Maruyama K, Tsukamoto S, Ohno S, et al.: Effect of cardiopulmonary resuscitation on intubation using a Macintosh laryngoscope, the AirWay Scope, and the gum elastic bougie: A manikin study. Resuscitation 81: 1014-1018, 2010
24) Komasawa N, Ueki R, Nomura H, et al.: Comparison of tracheal intubation by the Macintosh laryngoscope and Pentax-AWS (Airway Scope) during chest compression: a manikin study. J Anesth 24: 306-308, 2010
1) Hazinski MF, Nolan JP, Billi JE, et al.: Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 122 (Suppl 2): S250-S275, 2010
5) Suzuki A, Toyama Y, Katsumi N, et al.: The Pentax-AWS® rigid indirect video laryngoscope: clinical assessment of performance in 320 cases. Anaesthesia 63: 641-647, 2008
7) 駒澤伸泰，上農喜朗：初期臨床研修医における胸骨圧迫中の気管挿管─マッキントッシュ喉頭鏡とエアウェイスコープ®の比較─．日臨麻会誌 30：278-282，2010
14) Aoi Y, Inagawa G, Nakamura K, et al.: Airway scope versus macintosh laryngoscope in patients with simulated limitation of neck movements. J Trauma 69: 838-842, 2010
31) 吉村真一朗，松本恵，下里アキヒカリほか：Airway ScopeとMacintosh型喉頭鏡による心肺蘇生中の気管挿管─救急外来に搬入された心肺停止患者における比較検討─．日臨麻会誌 31：980-985，2011
33) Ueshima H, Asai T: Tracheal intubation in daylight and in the dark: a randomised comparison of the Airway Scope, Airtraq, and Macintosh laryngoscope in a manikin. Anaesthesia 65: 684-687, 2010
16) Nishikawa K, Matsuoka H, Saito S: Tracheal intubation with the PENTAX-AWS (airway scope) reduces changes of hemodynamic responses and bispectral index scores compared with the Macintosh laryngoscope. J Neurosurg Anesthesiol 21: 292-296, 2009
8) Baba M, Fujimoto J, Mizutani K, et al.: Tracheal intubation using Airway Scope in two patients with difficult airway during cardiopulmonary resuscitation. J Anesth 24: 618-620, 2010
32) Hirabayashi Y, Seo N: Airway Scope: early clinical experience in 405 patients. J Anesth 22: 81-85, 2008
12) Liu L, Tanigawa K, Kusunoki S, et al.: Tracheal intubation of a difficult airway using Airway Scope, Airtraq, and Macintosh laryngoscope: a comparative manikin study of inexperienced personnel. Anesth Analg 110: 1049-1055, 2010
23) Koyama J, Iwashita T, Okamoto K: Comparison of three types of laryngoscope for tracheal intubation during rhythmic chest compressions: a manikin study. Resuscitation 81: 1172-1174, 2010
26) Komasawa N, Ueki R, Itani M, et al.: Validation of the Pentax-AWS Airwayscope utility as an intubation device during cardiopulmonary resuscitation on the ground. J Anesth 24: 582-586, 2010
References_xml – reference: 9) Jones JH, Murphy MP, Dickson RL, et al.: Emergency physician-verified out-of-hospital intubation: miss rates by paramedics. Acad Emerg Med 11: 707-709, 2004
– reference: 10) Katz SH, Falk JL: Misplaced endotracheal tubes by paramedics in an urban emergency medical services system. Ann Emerg Med 37: 32-37, 2001
– reference: 28) Komasawa N, Ueki R, Kohama H, et al.: Comparison of Pentax-AWS Airwayscope video laryngoscope, Airtraq optic laryngoscope, and Macintosh laryngoscope during cardiopulmonary resuscitation under cervical stabilization: a manikin study. J Anesth 25: 898-903, 2011
– reference: 5) Suzuki A, Toyama Y, Katsumi N, et al.: The Pentax-AWS® rigid indirect video laryngoscope: clinical assessment of performance in 320 cases. Anaesthesia 63: 641-647, 2008
– reference: 32) Hirabayashi Y, Seo N: Airway Scope: early clinical experience in 405 patients. J Anesth 22: 81-85, 2008
– reference: 31) 吉村真一朗，松本恵，下里アキヒカリほか：Airway ScopeとMacintosh型喉頭鏡による心肺蘇生中の気管挿管─救急外来に搬入された心肺停止患者における比較検討─．日臨麻会誌 31：980-985，2011
– reference: 15) Suzuki A, Kunisawa T, Takahata O, et al.: Pentax-AWS( Airway Scope) for awake tracheal intubation. J Clin Anesth 19: 642-643, 2007
– reference: 23) Koyama J, Iwashita T, Okamoto K: Comparison of three types of laryngoscope for tracheal intubation during rhythmic chest compressions: a manikin study. Resuscitation 81: 1172-1174, 2010
– reference: 11) Shy BD, Rea TD, Becker LJ, et al.: Time to intubation and survival in prehospital cardiac arrest. Prehosp Emerg Care 8: 394-399, 2004
– reference: 17) Koyama Y, Nishihama M, Inagawa G, et al.: Comparison of haemodynamic responses to tracheal intubation using the Airway Scope® and Macintosh laryngoscope in normotensive and hypertensive patients. Anaesthesia 66: 895-900, 2011
– reference: 33) Ueshima H, Asai T: Tracheal intubation in daylight and in the dark: a randomised comparison of the Airway Scope, Airtraq, and Macintosh laryngoscope in a manikin. Anaesthesia 65: 684-687, 2010
– reference: 3) Koyama J, Aoyama T, Kusano Y, et al.: Description and first clinical application of AirWay Scope for tracheal intubation. J Neurosurg Anesthesiol 18: 247-250, 2006
– reference: 21) Sadamori T, Kusunoki S, Ishida M, et al.: Video laryngoscopy for emergency tracheal intubation during chest compression. Resuscitation 77: 155-156, 2008
– reference: 26) Komasawa N, Ueki R, Itani M, et al.: Validation of the Pentax-AWS Airwayscope utility as an intubation device during cardiopulmonary resuscitation on the ground. J Anesth 24: 582-586, 2010
– reference: 12) Liu L, Tanigawa K, Kusunoki S, et al.: Tracheal intubation of a difficult airway using Airway Scope, Airtraq, and Macintosh laryngoscope: a comparative manikin study of inexperienced personnel. Anesth Analg 110: 1049-1055, 2010
– reference: 30) 浅井隆：エアウェイスコープの現状と未来─マッキントッシュ喉頭鏡は今や無用の長物か？─．日臨麻会誌 30：611-618，2010
– reference: 7) 駒澤伸泰，上農喜朗：初期臨床研修医における胸骨圧迫中の気管挿管─マッキントッシュ喉頭鏡とエアウェイスコープ®の比較─．日臨麻会誌 30：278-282，2010
– reference: 6) Wang HE, Simeone SJ, Weaver MD, et al.: Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation. Ann Emerg Med 54: 645-652, 2009
– reference: 13) Takenaka I, Aoyama K, Iwagaki T, et al.: Approach combining the airway scope and the bougie for minimizing movement of the cervical spine during endotracheal intubation. Anesthesiology 110: 1335-1340, 2009
– reference: 20) Takenaka I, Aoyama K, Iwagaki T, et al.: Efficacy of the Airway Scope on tracheal intubation in the lateral position: comparison with the Macintosh laryngoscope. Eur J Anaesthesiol 28: 164-168, 2011
– reference: 1) Hazinski MF, Nolan JP, Billi JE, et al.: Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 122 (Suppl 2): S250-S275, 2010
– reference: 16) Nishikawa K, Matsuoka H, Saito S: Tracheal intubation with the PENTAX-AWS (airway scope) reduces changes of hemodynamic responses and bispectral index scores compared with the Macintosh laryngoscope. J Neurosurg Anesthesiol 21: 292-296, 2009
– reference: 14) Aoi Y, Inagawa G, Nakamura K, et al.: Airway scope versus macintosh laryngoscope in patients with simulated limitation of neck movements. J Trauma 69: 838-842, 2010
– reference: 19) Asai T: Tracheal intubation with restricted access: a randomised comparison of the Pentax-Airway Scope and Macintosh laryngoscope in a manikin. Anaesthesia 64: 1114-1117, 2009
– reference: 25) Han SK, Shin DH, Choi PC: Utility of the Pentax-AWS without interruption of chest compression: comparison of the Macintosh laryngoscope with the Pentax-AWS in manikin model. Resuscitation 81: 69-73, 2010
– reference: 2) Neumar RW, Otto CW, Link MS, et al.: Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122 (Suppl 3): S729-S767, 2010
– reference: 22) Sanuki T, Sugioka S, Hirokane M, et al.: Airway scope-assisted intubation during cardiopulmonary resuscitation without interruption of chest compression: the influence of chest compression rates. Resuscitation 82: 363-364, 2011
– reference: 29) Shin DH, Choi PC, Han SK: Tracheal intubation during chest compressions using Pentax-AWS®, GlideScope®, and Macintosh laryngoscope: a randomized crossover trial using a mannequin. Can J Anaesth 58: 733-739, 2011
– reference: 8) Baba M, Fujimoto J, Mizutani K, et al.: Tracheal intubation using Airway Scope in two patients with difficult airway during cardiopulmonary resuscitation. J Anesth 24: 618-620, 2010
– reference: 24) Komasawa N, Ueki R, Nomura H, et al.: Comparison of tracheal intubation by the Macintosh laryngoscope and Pentax-AWS (Airway Scope) during chest compression: a manikin study. J Anesth 24: 306-308, 2010
– reference: 18) Komasawa N, Ueki R, Itani M, et al.: Evaluation of tracheal intubation in several positions by the Pentax-AWS Airway Scope: a manikin study. J Anesth 24: 908-912, 2010
– reference: 27) Maruyama K, Tsukamoto S, Ohno S, et al.: Effect of cardiopulmonary resuscitation on intubation using a Macintosh laryngoscope, the AirWay Scope, and the gum elastic bougie: A manikin study. Resuscitation 81: 1014-1018, 2010
– reference: 4) Asai T, Liu EH, Matsumoto S, et al.: Use of the Pentax-AWS in 293 patients with difficult airways. Anesthesiology 110: 898-904, 2009
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[要旨] AHA2010年度版ACLSガイドラインは, 2005年度版に比してさらなる胸骨圧迫の質を強調している. 心肺蘇生中に胸骨圧迫の中断なく気管挿管ができれば, (1)連続的な胸骨圧迫, (2)効率的な肺を通した脳および心臓の酸素化, (3)気道保護による誤嚥防止, (4)カプノグラフィーによる蘇生の質の評価,...
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StartPage 117
SubjectTerms シミュレーション
二次救命処置
困難気道
気管挿管
間接声門視認型喉頭鏡
Title AHA-ACLS2010年版ガイドラインにおける気道管理と間接声門視認型喉頭鏡エアウェイスコープの可能性
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ispartofPNX 日本臨床麻酔学会誌, 2013, Vol.33(1), pp.117-123
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