Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Jouni Kurola, University of Eastern Finland, Finland
- Second opponent: Senior Consultant Geir Arne Sunde, Haukeland University Hospital, Norway
- Third member and chair of the evaluation committee: Professor II Harriet Akre, University of Oslo
Chair of the Defence
Professor Emeritus Ulf Erik Kongsgaard, University of Oslo
Principal Supervisor
Researcher Thomas Kristiansen, University of Oslo
Summary
Patients with a compromised airway requires rapid interventions to avoid hypoxic damage. The aims of this thesis were to examine emergency airway management strategies, in airway providers with different levels of competence, in different parts of the chain-of-survival. The main objective was to evaluate quality indicators regarding both technical- and non-technical skills and contribute with knowledge to review current standards of care in the field of emergency medicine.
A supraglottic airway device was implemented for use by firefighter first responders in adult out-of-hospital cardiac arrest. 502 firefighters from 35 fire stations received training. The device was used with success in 20 of 23 real life cardiac arrests (87%), which is comparable to results for paramedics.
Optimalization of operational factors can increase success in advanced airway management, but failed airway procedures can lead up to a “cannot intubate, cannot oxygenate”-situation. Norwegian air ambulance crews technical- and non-technical performance was assessed in a simulated scenario. 36 air ambulance crews solved a difficult airway with an emergency cricothyroidotomy. The procedure was 100% successful, with mean time to first ventilation 118 (SD: 70) seconds. Non-technical skills like situational awareness and resource utilization were evident. Compliance to procedural steps may be optimized to improve performance.
Finally, two different emergency cricothyroidotomy methods were compared in an experimental setting. For anaesthesiologists, a scalpel-based approach was significantly faster than the percutaneous. Recent training in the emergency cricothyroidotomy seems to be more important than clinical seniority and having performed the procedure in a clinical setting.
Overall, this thesis employed outcome parameters associated with the performance and quality of airway management. Results from this thesis can be of importance for airway management in time critical incidents.
Additional information
Contact the research support staff.