In this study, we hypothesized that in prehospital ambulance environments, the use of the triple airway maneuver-which facilitates airway patency in the mannequin-may allow for faster and easier placement of the Laryngeal Mask Airway (LMA). This study aimed to evaluate the effect of the triple airway maneuver on the LMA insertion times of paramedics with and without chest compression. This study was designed as a randomized, prospective, crossover simulated manikin study. Paramedics who were working in the Prehospital Command and Control Center were informed about the study. A randomized, crossover study design was used to reduce the learning curve of the participants. For each participant, four scenarios were created in a randomized order: 1) standard method with chest compressions, 2) triple airway maneuver with chest compressions, 3) standard method without chest compressions, and 4) triple airway maneuver without chest compressions. The study was carried out in a moving ambulance in an empty area. The standard method was defined as passive manual support of the head from below. For the triple airway maneuver, an emergency medicine specialist served as the second operator. The LMA application time was defined as the time until the LMA was held, and effective ventilation was provided. The primary outcome of the study was defined as the comparison of LMA insertion times of the standard method and triple airway maneuver for each method. Twenty-eight participants were included in the study. When all scenarios were compared LMA insertion times did not differ between triple airway maneuver and standard method groups (p = 0.730). During chest compressions, no statistically significant difference was found between the LMA insertion times (mean difference: 0.57 seconds, 95% CI: -0.819 to 1.961; p = 0.406). Similarly, when chest compressions were not applied, no significant difference was observed between the groups (mean difference: 0.5001 seconds, 95% CI: -2.00 to 3.50; p = 0.675). The findings of this study suggest that both the triple airway maneuver and the standard method may be effectively utilized in patients undergoing chest compressions as well as in those without chest compressions.

BACKGROUND: Selective lung intubation is a life-saving procedure in emergency departments. While various equipment can be used in selective lung intubation, most of this equipment is not readily available; therefore, single-lumen endotracheal intubations are performed for rapid interventions. MATERIALS AND METHODS: This study was designed as a randomized, prospective, cross-over study using the 90° rotation technique for selective intubation on a manikin model with and without endotracheal tube introducer (ETI) in difficult airway settings. Forty-six emergency physicians were included in the study. The primary outcome was evaluating time to selective intubations, and secondary outcomes were first and second attempt success rates and the self-perceived difficulty level of each method according to the participants. RESULTS: The mean time to the first successful endotracheal intubation was significantly longer for both right selective and left selective intubations with ETI utilization than without ([39.71 ± 9.83 vs. 21.86 ± 5.94 s], [P < 0.001]), ([42.2 ± 10.81 vs. 26.23 ± 7.97 s], [P < 0.001], respectively). The first-pass success rate did not differ for right selective intubation with or without an ETI (45/46 [97.8%] and 45/46 [97.8%], respectively). However, the first-pass success rate for left selective intubation was significantly higher with ETI as compared to without an ETI (30/46 [65.2%] and 13/46 [28.3%], respectively) (P < 0.001). CONCLUSIONS: While the success rates of right selective intubation were the same, the left selective intubation success rates with ETI are higher than the styletted endotracheal tube, which can be strong evidence for this method's applicability in practice. Expanding the use of ETI and increasing the experience of the practitioners can contribute to further success.

Background and Objectives: Temporalis muscle thickness (TMT) has emerged as an imaging-based morphometric surrogate associated with reduced muscle mass and frailty; however, its prognostic value in emergency department cardiac arrest (EDCA) remains unclear. This study aimed to evaluate the association between TMT and emergency department mortality in patients with EDCA who had cranial CT imaging available during the same emergency department encounter and to investigate its association with in-hospital mortality. Materials and Methods: This study included 129 adult patients who experienced cardiac arrest in the emergency department between 1 June 2022 and 31 May 2025, and had eligible cranial CT imaging available during the same emergency department encounter. TMT was measured on non-contrast brain computed tomography images. The association between TMT and mortality outcomes, including emergency department and in-hospital mortality, was statistically analyzed. Results: TMT was significantly lower in patients who died in the emergency department compared with survivors (median 3.29 mm [Q1–Q3: 2.63–3.95] vs. 4.69 mm [Q1–Q3: 3.70–5.65], p < 0.001). Similarly, patients who died in an in-hospital setting had lower TMT values than survivors (median 4.06 mm [Q1–Q3: 3.26–5.34] vs. 5.00 mm [Q1–Q3: 4.21–5.85], p = 0.040). ROC analysis demonstrated the moderate discriminative ability of TMT for predicting emergency department mortality (AUC = 0.763, 95% CI 0.671–0.856). Logistic regression analysis identified that, after adjustment for age, sex, and CPR duration, TMT remained associated with emergency department mortality (adjusted OR 0.34, 95% CI 0.133–0.886; p = 0.027). Conclusions: Among patients with EDCA who had eligible cranial CT imaging during the same emergency department encounter, lower temporalis muscle thickness was associated with increased emergency department mortality, whereas its association with in-hospital mortality was weaker. Given the retrospective design and limited number of outcome events, these findings should be considered exploratory and require validation in larger independent cohorts.