Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-23T11:52:27.891Z Has data issue: false hasContentIssue false
  • English
  • Français

An Analysis of Invasive Airway Management in a Suburban Emergency Medical Services System

Published online by Cambridge University Press:  28 June 2012

Thomas J. Krisanda ,
David R. Eitel ,
Dean Hess ,
Robert Ormanoski ,
Robert Bernini  and
Nancy Sabulsky
Thomas J. Krisanda*
Affiliation:
The Department of Emergency Medicine, York Hospital, York, Pa.
David R. Eitel
Affiliation:
The Department of Emergency Medicine, York Hospital, York, Pa.
Dean Hess
Affiliation:
The Department of Research, York Hospital, York, Pa.
Robert Ormanoski
Affiliation:
The Department of Emergency Medicine, Memorial Hospital, York, Pa.
Robert Bernini
Affiliation:
The Department of Emergency Medicine, York Hospital, York, Pa.
Nancy Sabulsky
Affiliation:
The Department of Research, York Hospital, York, Pa.
*
Department of Emergency Medicine, York Hospital, 1001 South George Street, York, PA 17405USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Airway management is the most critical and potentially life-saving intervention performed by emergency medical service (EMS) providers. Invasive airway management often is required in non-cardiac-arrest patients who are combative or otherwise uncooperative. The success of prehospital invasive airway management in this patient population was evaluated.

Methods:

A retrospective review was undertaken of the records of all such patients requiring endotracheal intubation over a three-year period (1987–1989). The study population included 278 patients enrolled by five advanced life support (ALS) units serving a suburban population of 425,000. Field trip sheets were reviewed for diagnosis, intubation method and success, number of intubation attempts, provider experience, reasons for unsuccessful intubations, and complications.

Results:

A total of 394 invasive airway management attempts were performed on 278 patients. The overall successful intubation rate was 75% (41 % orotracheal, 52% nasotracheal, 7% other or unknown). The most common diagnoses were COPD and pulmonary edema (30%) and trauma (24%). Experienced providers were successful on the first attempt in 57% of cases compared to 50% by inexperienced providers (p=.24). Multiple intubation attempts were required in 33% of the patients. There was no statistically significant difference in success rates between the orotracheal and nasotracheal methods (p=.51). The most common reason for unsuccessful intubation was altered level of consciousness. Complications occurred with 7% of successful attempts and in 18% of unsuccessful attempts (p<.001). Forty-six percent of the patients who were not intubated successfully in the field and required intubation in the emergency department (ED) received a neuromuscular blocking agent prior to successful intubation.

Conclusion:

Prehospital providers can intubate a high but improvable proportion of non-cardiac-arrested patients by both the orotracheal and nasotracheal routes. The use of pharmacologic adjuncts to facilitate the prehospital intubation of selected, non-cardiac-arrested patients is a promising adjunct that needs further evaluation.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 7 , Issue 2 , June 1992 , pp. 121 - 126
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Stewart, RD, Paris, PM, Winter, PM et al. : Field endotracheal intubation by paramedical personnel. Chest 1984;85:341–345.CrossRefGoogle ScholarPubMed
2. Pepe, PE, Copass, MD, Joyce, TJ: Prehospital endotracheal intubation: Rationale for training emergency medical personnel. Ann Emerg Med 1985;14:1085–1092.CrossRefGoogle ScholarPubMed
3. O'Brien, DJ, Danzl, DF, Hooker, EA et al. : Prehospital blind nasotracheal intubation by paramedics. Ann Emerg Med 1989;18:612–617.CrossRefGoogle ScholarPubMed
4. Jacobs, LM, Berrizbeitia, LD, Bennett, B, Madigan, C: Endotracheal intubation in the prehospital phase of emergency medical care. JAMA 1983;250:16.CrossRefGoogle ScholarPubMed
5. Pointer, JE: Clinical characteristics of paramedics' performance of pediatric endotracheal intubation. Am J Emerg Med 1989;7:364–366.CrossRefGoogle ScholarPubMed
6. Losek, JD, Bonadio, WA, Walsh-Kelly, C et al. : Prehospital pediatric endotracheal intubation performance review. Ped Emerg Care 1989;5:l–4.CrossRefGoogle ScholarPubMed
7. DeLeo, BC: Endotracheal intubation by rescue squad personnel. Chest 1984;85:341–345.Google Scholar
8. Pointer, JE: Clinical characteristics of paramedics' performance of endotracheal intubation. J Emerg Med 1988;6:505–509.CrossRefGoogle ScholarPubMed
9. Aijian, P, Tsai, A, Knopp, R, Kallsen, GW: Endotracheal intubation of pediatric patients by paramedics. Ann Emerg Med 1989;18:489–494.CrossRefGoogle ScholarPubMed
10. Hedges, JR, Dronen, SC, Feero, S et al. : Succinyl-choline-assisted intubations in prehospital care. Ann Emerg Med 1988;17:469–472.CrossRefGoogle ScholarPubMed