Login to myESAIC Membership
Back

About

The ESAIC is dedicated to supporting professionals in anaesthesiology and intensive care by serving as the hub for development and dissemination of valuable educational, scientific, research, and networking resources.


Back

Congresses

The ESAIC hosts the Euroanaesthesia and Focus Meeting congresses that serve as platforms for cutting-edge science and innovation in the field. These events bring together experts, foster networking, and facilitate knowledge exchange in anaesthesiology, intensive care, pain management, and perioperative medicine. Euroanaesthesia is one of the world’s largest and most influential scientific congresses for anaesthesia professionals. Held annually throughout Europe, our congress is a contemporary event geared towards education, knowledge exchange and innovation in anaesthesia, intensive care, pain and perioperative medicine, as well as a platform for immense international visibility for scientific research.


Back

Professional Growth

The ESAIC's mission is to foster and provide exceptional training and educational opportunities. The ESAIC ensures the provision of robust and standardised examination and certification systems to support the professional development of anaesthesiologists and to ensure outstanding future doctors in the field of anaesthesiology and intensive care.


Back

Research

The ESAIC aims to advance patient outcomes and contribute to the progress of anaesthesiology and intensive care evidence-based practice through research. The ESAIC Clinical Trial Network (CTN), the Academic Contract Research Organisation (A-CRO), the Research Groups and Grants all contribute to the knowledge and clinical advances in the peri-operative setting.


Learn more about the ESAIC Clinical Trial Network (CTN) and the associated studies.

Back

EU Projects

The ESAIC is actively involved as a consortium member in numerous EU funded projects. Together with healthcare leaders and practitioners, the ESAIC's involvement as an EU project partner is another way that it is improving patient outcomes and ensuring the best care for every patient.


Back

Patient Safety

The ESAIC aims to promote the professional role of anaesthesiologists and intensive care physicians and enhance perioperative patient outcomes by focusing on quality of care and patient safety strategies. The Society is committed to implementing the Helsinki Declaration and leading patient safety projects.


Back

Sustainability

To ESAIC is committed to implementing the Glasgow Declaration and drive initiatives towards greater environmental sustainability across anaesthesiology and intensive care in Europe.


Back

Partnerships

The ESAIC works in collaboration with industry, national societies, and specialist societies to promote advancements in anaesthesia and intensive care. The Industry Partnership offers visibility and engagement opportunities for industry participants with ESAIC members, facilitating understanding of specific needs in anaesthesiology and in intensive care. This partnership provides resources for education and avenues for collaborative projects enhancing science, education, and patient safety. The Specialist Societies contribute to high-quality educational opportunities for European anaesthesiologists and intensivists, fostering discussion and sharing, while the National Societies, through NASC, maintain standards, promote events and courses, and facilitate connections. All partnerships collectively drive dialogue, learning, and growth in the anaesthesiology and intensive care sector.


Back

Guidelines

Guidelines play a crucial role in delivering evidence-based recommendations to healthcare professionals. Within the fields of anaesthesia and intensive care, guidelines are instrumental in standardizing clinical practices and enhancing patient outcomes. For many years, the ESAIC has served as a pivotal platform for facilitating continuous advancements, improving care standards and harmonising clinical management practices across Europe.


Back

Publications

With over 40 years of publication history, the EJA (European Journal of Anaesthesiology) has established itself as a highly respected and influential journal in its field. It covers a wide range of topics related to anaesthesiology and intensive care medicine, including perioperative medicine, pain management, critical care, resuscitation, and patient safety.


Back

Membership

Becoming a member of ESAIC implies becoming a part of a vibrant community of nearly 8,000 professionals who exchange best practices and stay updated on the latest developments in anaesthesiology, intensive care and perioperative medicine. ESAIC membership equips you with the tools and resources necessary to enhance your daily professional routine, nurture your career growth, and play an active role in advancing anaesthesiology, intensive care and perioperative medicine.


Membership opportunities
at the ESAIC

Newsletter 2020

Advanced Airway Management During CPR

The chief editor note:
As every year we publish some abstracts of lectures to be presented at the annual Euroanaesthesia November 28-30 2020, Barcelona.

Kemal Tolga Saracoglu, MD
saracoglukt@gmail.com

Providing effective airway and oxygenation are among the main components of advanced life support. The points that determine the issue to be controversial are the absence of evidence that a routine tool or basic method should be at the forefront of airway management during cardiac arrest. There is no consensus yet on the best airway management strategy to improve patient outcome. Several studies have been conducted on this issue and this manuscript aimed to evaluate the most important results.

The European Resuscitation Council (ERC) and the American Heart Association (AHA) recommend tracheal intubation (TI) to secure the airway by qualified and properly trained staff. Although controversial, in the absence of personal skills in TI, the supraglottic airway device (SGA) or mask ventilation (BMV) are two other acceptable alternatives.

The 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science reported that either advanced airway or a bag-mask device can be used during CPR (1). The American Heart Association stated that cardiac arrest requires TI within the first 15 minutes in 60% to 70% of patients (2). The incidence of unrecognised oesophagal intubation has been reported as 2.4-17% in studies involving paramedics (3). Besides 3% tracheal tube displacement, 3% multiple intubation attempts, hyperoxemia and long-term interruption in CPR were observed. All were associated with increased risk for intubation related adverse events including a negative effect on coronary and cerebral perfusion. According to the ERC recommendation, tracheal intubation should not last longer than 5 seconds. In cardiac arrest studies, unrecognised misplacement of the tracheal tube has been reported to be associated with morbidity and mortality ranging from 2.9-16.7% (4).

The prevalence of difficult airway incidence in prehospital settings can reach up to 20%. There is a wide range of complications. The incidence of cannot ventilate, cannot intubate scenarios was reported as 1% (5). In an observational study of two institutions, the peri-intubation cardiac arrest rate was reported as fifteen episodes during one year period, accounting for 3.6% of all inpatient arrests (6).

The success rate of paramedics in the first tracheal intubation attempt was reported as 71.4% (7). The mean success rate of CPR interruptions due to tracheal intubation was 109.5 seconds, with a success rate of 91.5% in the 4th attempt. A 14 times risk of increased severe hypoxemia, 7 times increased risk of regurgitation and 4 times increased aspiration risk were reported with more than two intubation attempts.

Compared to BMV, the risk of gastric distension with SGA is lower. SGA placement has gained popularity due to its simple technique and less CPR interruption than tracheal intubation. It was first proposed by the 1997 Liaison Committee on Resuscitation (ILCOR) as an alternative airway management tool to TI in adults during resuscitation.

In the Cardiac Arrest Registry to Enhance Survival (CARES) study, an advanced airway device was used in approximately 80% of the 10,691 out of hospital cardiac arrest patients (8). About two-thirds of patients were intubated and supraglottic airway devices were used in one third. The King LT was the most commonly used SGA. However, compared to SGA, intubated patients were older, and more often male. In addition, the incidence of defibrillation with public AED was lower in these patients. Return of spontaneous circulation (ROSC), hospital survival and neurological outcome results were better. On the other hand, the AIRWAYS-2 study, which included 9296 out of hospital cardiac arrest patients (4886 SGA group and 4410 in the tracheal intubation group), a favourable functional outcome at 30 days did not differ significantly in the AIRWAYS-2 study (9).

In Jabre’s study (10) 2043 patients with out-of-hospital cardiorespiratory arrest in France and Belgium were enrolled. BVM and TI were compared. In the BMV group, regurgitation of gastric content was significantly higher and the rate of ROSC was significantly lower (34.2% vs 38.9%). Benger et al. (9) and Wang et al. (11) compared SGA and TI in the non-physician-based system. The TI success rates were 98% in the Jabre et al. trial, 70% in the Benger et al. trial, and 52% in the Wang et al. trial. Overall, there was no high-certainty evidence to recommend an advanced airway strategy over BMV. Besides, a specific advanced airway device was not recommended either.

Many studies in the literature focused on outcome analysis. However significant differences could not be found in patients with TI or SGA in both retrospective and prospective studies. In a study that retrospectively analysed ambulance records between 2013 and 2014, the data of 209 patients revealed no difference in terms of neurological outcome (12).

In a meta-analysis ROSC, survival to hospital admission, survival to hospital discharge and neurologically intact survival to hospital discharge were investigated for outcome analysis (13). Traumatic cardiac arrest, paediatric patients, rapid sequence induction and videolaryngoscopic intubations were excluded. In this study, 34,533 patients were included in the TI group and 41,116 patients in the SGA group. Compared to SGA, statistically significant higher ROSC rates ([OR] 1.28, 95% confidence interval [CI] 1.05-1.55) and longer duration of hospital stay (OR 1.34, CI 1.03-1.5) were observed in intubated patients. However, when this study is interpreted, there was a lack of control for confounders such as shockable rhythm, witnessed arrest or bystander CPR. This leads to bias and causes confusion.

Conclusion:

The available guidelines are predominantly based on evidence from observational studies and agreed consensus; new and ongoing randomised controlled trials should provide more information. We have no data supporting the routine use of any specific approach for airway management during cardiac arrest. The best technique depends on the conditions in which cardiac arrest occurs and the rescuer’s experience is also important. Tracheal intubation requires a high level of skills and competence. Therefore it is important to have a periodic skill maintenance program.

References

  1. Soar J, Callaway CW, Aibiki M, et al. Resuscitation 2015;95:e71_e120.
  2. Andersen LW, Granfeldt A, Callaway CW, et al. JAMA 2017;317:494_506.
  3. Jarvis JL, Barton D, Wang H. Resuscitation.2018;130:57-60.
  4. Chou HC, Chong KM, Sim SS, et al. Resuscitation 2013;84:1708-12.
  5. Schalk R,Seeger FH,Mutlak H, et al. Resuscitation. 2014 Nov;85(11):1629-32.
  6. Park C.. Acute Crit Care.2019;34:212-218.
  7. Wang HESimeone SJWeaver MD et al. Ann Emerg Med. 2009 Nov;54(5):645-652.e1.
  8. McMullan JGerecht R, et al.; . Resuscitation. 2014;85:617-22.
  9. Benger JRKirby KBlack S, et al… JAMA. 2018;320:779-791.
  10. Jabre P,Penaloza A,et al, l. JAMA. 2018;319:779-787.
  11. WangHE, Schmicker RH, Daya MR, et al.. JAMA 2018;320:769-778.
  12. Edwards T,Williams J,Cottee M. Emerg Med Australas. 2019 Feb;31(1):76-82.
  13. Benoit JLGerecht RBSteuerwald MTet al.. Resuscitation. 2015 Aug;93:20-6.