Military Standard Testing of Commercially Available Supraglottic Airway Devices for Use in a Military Combat Setting.

INTRODUCTION: Airway obstruction is the second leading cause of death on the battlefield. The harsh conditions of the military combat setting require that devices be able to withstand extreme circumstances. Military standards (MIL-STD) testing is necessary before devices are fielded. We sought to determine the ability of supraglottic airway (SGA) devices to withstand MIL-STD testing. METHODS: We tested 10 SGA models according to nine MIL-STD-810H test methods. We selected these tests by polling five military and civilian emergency-medicine subject matter experts (SMEs), who weighed the relevance of each test. We performed tests on three devices for each model, with operational and visual examinations, to assign a score (1 to 10) for each device after each test. We calculated the final score of each SGA model by averaging the score of each device and multiplying that by the weight for each test, for a possible final score of 2.6 to 26.3. RESULTS: The scores for the SGA models were LMA Classic Airway, 25.9; AuraGain Disposable Laryngeal Mask, 25.5; i-gel Supraglottic Airway, 25.2; Solus Laryngeal Mask Airway, 24.4; LMA Fastrach Airway, 24.4; AuraStraight Disposable Laryngeal Mask, 24.1; King LTS-D Disposable Laryngeal Tube, 22.1; LMA Supreme Airway, 21.0; air-Q Disposable Intubating Laryngeal Airway, 20.1; and Baska Mask Supraglottic Airway, 18.1. The limited (one to three) samples available for testing provide adequate preliminary information but restrict the range of failures that could be discovered. CONCLUSIONS: Lower scoring SGA models may not be optimal for military field use. Models scoring sufficiently close to the top performers (LMA Classic, AuraGain, i-gel, Solus, LMA Fastrach, AuraStraight) may be viable for use in the military setting. The findings of our testing should help guide device procurement appropriate for different battlefield conditions.

Review of Commercially Available Supraglottic Airway Devices for Prehospital Combat Casualty Care.

BACKGROUND: Airway obstruction is the second leading cause of potentially survivable death on the battlefield. The Committee on Tactical Combat Casualty Care lists airway optimization among the top 5 battlefield research and development priorities; however, studies show that combat medics lack access to the recommended supraglottic airway (SGA) devices. SGA devices are an alternative airway management technique to endotracheal tube intubation. Reports have shown SGA devices are easier to use and take fewer attempts to provide patent airflow to the patient when compared to endotracheal tube intubation. Military settings require a higher degree of skill to perform airway management on patients due to the environment, limited availability of equipment, and potential chaos of the battlefield. Finding the optimal SGA device for the military setting is an unmet need. The International Organization for Standardization describes basic functional requirements for SGA devices, as well as patient configurations and size limitations. Beyond that, no SGA device manufacturer states that their devices are intended for military settings. MATERIALS AND METHODS: We conducted a market review of 25 SGA devices that may meet inclusion into the medics' aid bag. The company's official "Instructions for Use" document, Google Scholar, and FDA reports were reviewed to obtain information for each SGA device. RESULTS: Twenty-five commercially available SGA devices are explored from manufacturer online sources. A commercially available device list is shown later in this paper, which provides the device's features, indications, and contraindications based on the manufacturer's product information documentation. CONCLUSIONS: There are a variety of devices that require further testing to determine whether they should be included in sets, kits, and outfits.

The mechanism of pyrolysis of benzyl azide: spectroscopic evidence for benzenemethanimine formation.

We study the gas-phase pyrolysis of benzyl azide (BA, C6H5CH2N3) using ultraviolet photoelectron spectroscopy (UVPES) and matrix-isolation infrared (IR) spectroscopy, together with electronic structure calculations and Rice-Ramsperger-Kassel-Marcus (RRKM) calculations. It is found that BA decomposes via N2 elimination at ca. 615 K, primarily yielding benzenemethaninime. Other end products include HCN and C6H6. N-Methyleneaniline is not detected, although its formation at higher temperature is foreseen by RRKM calculations.

A study of the alkene-ozone reactions, 2,3-dimethyl 2-butene + O3 and 2-methyl propene + O3, with photoelectron spectroscopy: measurement of product branching ratios and atmospheric implications.

The reactions of ozone with the alkenes 2,3-dimethyl 2-butene (DMB) and 2-methyl propene (2MP) have been investigated using a flow-tube interfaced to a u.v. photoelectron spectrometer. These reactions were studied at low pressure at different reagent partial pressures, both with the alkene in excess and ozone in excess. In each case, photoelectron spectra recorded as a function of time have been used to estimate partial pressures of the reagents and products as a function of time using photoionization cross-sections of selected photoelectron bands of the reagents and products, which were measured separately. The yields of all the main products have been determined, some of which have been measured in previous studies. For each reaction, oxygen was observed as a product for the first time and its yield was measured. Kinetics simulations were performed using reaction schemes which were developed for these reactions, which are consistent with that used earlier for the ozone-ethene reaction, in order to determine the main reactions for production of the products. The experimental product yields have been used in a global model to estimate their global annual emissions in the atmosphere. For example, for the reaction of O(3) with 2MP the formaldehyde, formic acid and acetone global annual emissions are calculated as 0.4 Tg, 25.0 Gg and 0.16 Tg respectively, which are estimated as 0.02, 0.3 and 0.2% of the total annual emission respectively. For the reaction of O(3) with DMB, the acetone yield is higher at 0.9 Tg which is approximately 1% of the total annual estimated emission.

A study of the ethene-ozone reaction with photoelectron spectroscopy: measurement of product branching ratios and atmospheric implications.

The ozone-ethene reaction has been investigated at low pressure in a flow-tube interfaced to a u.v. photoelectron spectrometer. Photoelectron spectra recorded as a function of reaction time have been used to estimate partial pressures of the reagents and products, using photoionization cross-sections for selected photoelectron bands of the reagents and products, which have been measured separately. Product yields compare favourably with results of other studies, and the production of oxygen and acetaldehyde have been measured as a function of time for the first time. A reaction scheme developed for the ozone-ethene reaction has been used to simulate the reagents and products as a function of time. The results obtained are in good agreement with the experimental measurements. For each of the observed products, the simulations allow the main reaction (or reactions) for production of that product to be established. The product yields have been used in a global model to estimate their global annual emissions in the atmosphere. Of particular interest are the calculated global annual emissions of formaldehyde (0.96 ± 0.10 Tg) and formic acid, (0.05 ± 0.01 Tg) which are estimated as 0.04% and 0.7% of the total annual emission respectively.