Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-24T02:38:36.810Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of tracheal intubation and alternative airway techniques performed in the prehospital setting by paramedics: a systematic review

Published online by Cambridge University Press:  21 May 2015

Jan L. Jensen ,
Ka Wai Cheung ,
John M. Tallon  and
Andrew H. Travers
Jan L. Jensen*
Affiliation:
Division of Emergency Medical Services, Dalhousie University, Dartmouth, NS Emergency Health Services, Dartmouth, NS
Ka Wai Cheung
Affiliation:
Emergency Department, Vancouver General Hospital, Vancouver, BC
John M. Tallon
Affiliation:
Division of Emergency Medical Services, Dalhousie University, Dartmouth, NS
Andrew H. Travers
Affiliation:
Emergency Health Services, Office of the Provincial Medical Director, Dartmouth, NS
*
Emergency Medical Services, QEII Health Sciences Centre, 1796 Summer St., Rm. 3022, Halifax NS B3H 3A7; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

This systematic review included controlled clinical trials comparing tracheal intubation (TI) with alternative airway techniques (AAT) (bag-mask ventilation and use of extraglottic devices) performed by paramedics in the prehospital setting. A priori outcomes to be assessed were survival, neurologic outcome, airway management success rates and complications. We identified trials using EMBASE, MEDLINE, CINAHL, The Cochrane Library, Web of Science, author contacts and hand searching. We included 5 trials enrolling a total of 1559 patients. No individual study showed any statistical difference in outcomes between the TI and AAT groups. Because of study heterogeneity, we did not pool the data. This is the most comprehensive review to date on paramedic trials. Owing to the heterogeneity of prehospital systems, administrators of each system must individually consider their airway management protocols.

Keywords

paramedicprehospitalairwaytracheal intubationextraglotticsupraglotticbag-mask ventilation
Type
State of the Art • À la fine pointe
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 2 , March 2010 , pp. 135 - 140
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

REFERENCES

1.Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Guidelines for cardiopul-monary resuscitation and emergency cardiac care. Part VI. Pediatric advanced life support. JAMA 1992;268:2262–75.Google Scholar
2.Dunham, CM, Barraco, RD, Clark, DE, et al. Guidelines for emergency tracheal intubation immediately after traumatic injury. J Trauma 2003;55:162–79.CrossRefGoogle ScholarPubMed
3.Winchell, RJ, Hoyt, DB. Endotracheal intubation in the field improves survival in patients with severe head injury. Arch Surg. 1997;132:592–7.Google Scholar
4.Losek, JD, Hennes, H, Glaeser, P, et al. Prehospital care of the pulseless, non-breathing pediatric patient. Am J Emerg Med 1987;5:370–4.CrossRefGoogle Scholar
5.Sirbaugh, PE, Pepe, PE, Shook, JE, et al. A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric car-diopulmonary arrest. Ann Emerg Med 1999;33:174–84.Google Scholar
6.Stiell, IG, Wells, GA, Field, B, et al. Advanced cardiac life support in out-of-hospital cardiac arrest. NEnglJ Med 2004;351:647–56.Google Scholar
7.Stiell, IG, Nesbitt, LP, Pickett, W, et al. The OPALS major trauma study: impact of advanced life-support on survival and morbidity. CMAJ 2008;178:1141–52.CrossRefGoogle ScholarPubMed
8.Murray, JA, Demetriades, D, Berne, TB, et al. Prehospital intubation in patients with severe head injury. J Trauma 2000;49:1065–70.Google Scholar
9.Davis, DP, Hoyt, DB, Ochs, M, et al. The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury. J Trauma 2003;54:444–53.CrossRefGoogle ScholarPubMed
10.Bochicchio, GV, Ilahi, O, Joshi, M, et al. Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal brain injury. J Trauma 2003;54:307–11.CrossRefGoogle Scholar
11.Warner, KJ, Cuschieri, J, Copass, MK, et al. The impact of prehospital ventilation on outcome after severe traumatic brain injury. J Trauma. 2007;62:1330–6.Google ScholarPubMed
12.Chi, JH, Knudson, MM, Vassar, MJ, et al. Prehospital hypoxia affects outcome in patients with traumatic brain injury: a prospective multicenter study. J Trauma 2006;61:1134–41.Google Scholar
13.Jadad, AR, Moore, RA, Carroll, D, et al. Assessing the quality of reports of randomized control trials: Is blinding necessary? Control Clin Trials 1996;17:1–12.CrossRefGoogle ScholarPubMed
14.Higgins, JPT, Green, S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration; 2009. Available: http://www.cochrane-handbook.org (accessed 2010 Jan 21).Google Scholar
15.Higgins, JP, Thompson, SG, Deek, JJ. Measuring inconsistency in meta-analyses. BMJ 2003;327:557–60.Google Scholar
16.Breslow, NE, Day, NE. Statistical methods in cancer research. Volume I — the analysis of case-control studies. IARC Sci Publ 1980:5–338.Google Scholar
17.Egger, M, Davey Smith, G, Schneider, M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629–34.CrossRefGoogle ScholarPubMed
18.Gausche, M, Lewis, RJ, Stratton, SJ, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome. JAMA 2000;283:783–90.CrossRefGoogle ScholarPubMed
19.Bartlett, RL, Martin, SD, McMahon, JM, et al. A field comparison of the pharyngeotracheal lumen airway and the endotracheal tube. J Trauma 1992;32:280–4.Google Scholar
20.Goldenberg, IF, Campion, BC, Siebold, CM, et al. Morbidity and mortality in patients receiving the esophageal obturator airway and the endotracheal tube in prehospital cardiopul-monary arrest. Minn Med 1986;69:707–13.Google Scholar
21.Staudinger, T, Brugger, S, Roggla, M, et al. Comparison of the combitube with the endotracheal tube in cardiopul-monary resuscitation in the prehospital phase. Wien Klin Wochenschr 1994;106:412–5.Google Scholar
22.Rumball, C, MacDonald, D, Barber, P, et al. Endotracheal intubation and esophageal tracheal combitube insertion by regular ambulance attendants: a comparative trial. Prehosp Emerg Care 2004;8:15–22.CrossRefGoogle ScholarPubMed
23.Lecky, F, Bryden, D, Little, R, et al. Emergency intubation for acutely ill and injured patients. Cochrane Database Syst Rev 2008;2:CD001429.Google Scholar
24.Mulcaster, JT, Mills, J, Hung, OR, et al. Laryngoscopic intubation: learning and performance. Anaesthesiology 2003;98:23–7.Google Scholar
25.Kovacs, G, Bullock, G, Ackroyd-Stolarz, S, et al. A randomized controlled trial on the effect of educational interventions in promoting airway management skill maintenance. Ann Emerg Med 2000;36:301–9.Google Scholar
26.Wang, HE, Katz, SH. Cognitive control and prehospital endotracheal intubation. Prehosp Emerg Care 2007;11:234–9.Google Scholar