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Factors Influencing Successful Intubation in the Prehospital Setting

Published online by Cambridge University Press:  28 June 2012

James V. Doran ,
Bartholomew J. Tortella ,
Walter J. Drivet  and
Robert F. Lavery
James V. Doran*
Affiliation:
The University of Medicine and Dentistry of New Jersey, University Hospital, Department of Surgery, Division of Trauma, Trauma and Emergency Medical Services Research, Newark, New Jersey
Bartholomew J. Tortella
Affiliation:
The University of Medicine and Dentistry of New Jersey, University Hospital, Department of Surgery, Division of Trauma, Trauma and Emergency Medical Services Research, Newark, New Jersey
Walter J. Drivet
Affiliation:
The University of Medicine and Dentistry of New Jersey, University Hospital, Emergency Medical Services, Newark, New Jersey
Robert F. Lavery
Affiliation:
The University of Medicine and Dentistry of New Jersey, University Hospital, Department of Surgery, Division of Trauma, Trauma and Emergency Medical Services Research, Newark, New Jersey
*
UMDNJ - University Hospital, Division of Trauma and Emergency Medical Services, 150 Bergen St., J-204, Newark, NJ 07103USA
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Abstract

Objective:

To explore the determinants influencing oral/nasal endotracheal intubation (OETI/NETI) and determine which cognitive, therapeutic, and technical interventions may assist prehospital airway management.

Design, Setting, and Participants:

Prospective review of run reports and structured interviews of paramedics involved in OETI/NETI attempts were conducted in a high-volume, inner-city, advanced life support (ALS) system during an eight-month period (July 1991 to February 1992). Data were abstracted from run reports, and paramedics were asked in structured interviews to describe difficulties in OETI/NETI attempts.

Results:

Of 236 patients studied, 88% (208) were intubated successfully. Success/failure rate was not related statistically to patients' ages (p = 0. 78), medical or trauma complaint (89% vs 85%, p = 0.35), oral versus nasal route (88% vs 85%, p = 0.38), care time (scene + transport times: success, 18 minutes; failure, 20 minutes, p = 0.30), paramedic seniority (p = 0.13), or number of attempts per paramedic (p >0.05). Increased level of consciousness (LOC) was associated with decreased success rate (p = 0.04). Paramedics reported difficulties in endotracheal intubation (ETI) attempts in 110 (46.6%) of patients. Factors reported to increase ETI difficulty were: 1) technical problems (35.6%); 2) mechanical problems (15.6%); and 3) combative patients (12.7%).

Conclusions:

Oral endotracheal intubation and NETI success rates identified in this study are similar to those described in the literature, although innovative strategies could be used to facilitate prehospital airway management. Many of the factors found to increase ETI difficulty could be ameliorated by the administration of paralytic agents, that is, for combative patients. Focused training in cadaver and animal labs coupled with recurrence training in the operating suites should be used on a regular basis to decrease difficulties in visualization. Interventions directed at alleviating mechanical difficulties that should be explored include new-to-the-field techniques, such as retrograde intubation, fiber-optic technology, and surgical tracheal access.

Keywords

advanced life supportcardiac arrestemergency medical servicesinjury intubationnasotracheal intubationorotracheal intubationparamedicsprehospital carewounds
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 10 , Issue 4 , December 1995 , pp. 259 - 264
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1995

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