Abstract
IntroductionPre-hospital airway management is a key component of resuscitation although the benefit of pre-hospital intubation has been widely debated. We report a large series of pre-hospital emergency airway encounters performed by air-transport providers in a large, multi-state system.MethodsWe retrospectively reviewed electronic intubation flight records from an 89 rotorcraft air medical system from January 01, 2007, through December 31, 2009. We report patient characteristics, intubation methods, success rates, and rescue techniques with descriptive statistics. We report proportions with 95% confidence intervals and binary comparisons using chi square test with p-values <0.05 considered significant.Results4,871 patients had active airway management, including 2,186 (44.9%) medical and 2,685 (55.1%) trauma cases. There were 4,390 (90.1%) adult and 256 (5.3%) pediatric (age ≤ 14) intubations; 225 (4.6%) did not have an age recorded. 4,703 (96.6%) had at least one intubation attempt. Intubation was successful on first attempt in 3,710 (78.9%) and was ultimately successful in 4,313 (91.7%). Intubation success was higher for medical than trauma patients (93.4% versus 90.3%, p=0.0001 JT test). 168 encounters were managed primarily with an extraglottic device (EGD). Cricothyrotomy was performed 35 times (0.7%) and was successful in 33. Patients were successfully oxygenated and ventilated with an endotracheal tube, EGD, or surgical airway in 4809 (98.7%) encounters. There were no reported deaths from a failed airway.ConclusionAirway management, predominantly using rapid sequence intubation protocols, is successful within this high-volume, multi-state air-transport system.
Highlights
Pre-hospital airway management is a key component of resuscitation the benefit of pre-hospital intubation has been widely debated
Protocols, oversight, and frequency of individual provider intubation all might influence success rates and clinical outcome, and previous reports may not represent success rates possible from highly skilled clinicians working in high volume systems.[6,7]
Previous small studies of air transport intubations have found success rates from 66% to 97%, with higher success seen after the institution of rapid sequence intubation (RSI) protocols.[8,9,10,11,12,13]
Summary
Pre-hospital airway management is a key component of resuscitation the benefit of pre-hospital intubation has been widely debated. We report a large series of pre-hospital emergency airway encounters performed by air-transport providers in a large, multi-state system. Prior research on patient outcomes after pre-hospital intubation has yielded mixed results with several studies suggesting that, in select groups of trauma patients, it may increase mortality.[1,2,3,4,5] Training, protocols, oversight, and frequency of individual provider intubation all might influence success rates and clinical outcome, and previous reports may not represent success rates possible from highly skilled clinicians working in high volume systems.[6,7] Previous small studies of air transport intubations have found success rates from 66% to 97%, with higher success seen after the institution of rapid sequence intubation (RSI) protocols.[8,9,10,11,12,13] We report a large consecutive series of intubations performed within an 89 rotorcraft, multi-state transport system in order to characterize methods, success rates and rescue techniques.
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