Airway Management Success and Hypoxemia Rates in Air and Ground Critical Care Transport: a Prospective Multicenter Study

Abstract

ABSTRACTObjective. To assess critical care transport (CCT) crews’ endotracheal intubation (ETI) attempts, success rates, and peri-ETI oxygenation. Methods. Participants were adult and pediatric patients undergoing attempted advanced airway management during the period from July 2007 to December 2008 by crews from 11 CCT programs varying in geography, crew configuration, and casemix; all crews had access to neuromuscular-blocking agents. Data collected included airway management variables defined per national consensus criteria. Descriptive analysis focused on ETI success rates (reported with exact binomial 95% confidence intervals [CIs]) and occurrence of new hypoxemia (oxygen saturation [SpO2] dropping below 90% during or after ETI); to assess categorical variables, Fisher's exact test, Pearson χ2, and logistic regression were employed to explore associations between predictor variables and ETI failure or new hypoxemia. For all tests, p < 0.05 defined significance. Results. There were 603 total attempts at airway management, with successful oral or nasal ETI in 582 cases, or 96.5% (95% CI 94.7–97.8%). In 182 cases (30.2%, 95% CI 26.5–34.0%), there were failed ETI attempts prior to CCT crew arrival; CCT crew ETI success on these patients (96.2%, 95% CI 92.2–98.4%) was just as high as in the patients in whom there was no pre-CCT ETI attempt (p = 0.81). New hypoxemia occurred in only six cases (1.6% of the 365 cases with ongoing SpO2 monitoring; 95% CI 0.6–3.5%); the only predictor of new hypoxemia was pre-ETI hypotension (p < 0.001). A requirement for multiple ETI attempts by CCT crews was not associated with new hypoxemia (Fisher's exact p = 0.13). Conclusions. CCT crews’ ETI success rates were very high, and even when ETI required multiple attempts, airway management was rarely associated with SpO2 derangement. CCT crews’ ETI success rates were equally high in the subset of patients in whom ground emergency medical services (EMS) ETI failed prior to arrival of transport crews.