Abstract
BackgroundTracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative.MethodsWe conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy.ResultsFPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified.ConclusionAirway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.
Highlights
Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative
428 patients were intubated by the helicopter emergency medical service (HEMS) crew and 316 of these intubation procedures (73.8%) were video-recorded in full, the results of the questionnaire were available for all 428 patients
We found no correlation between the amount of work experience in anaesthesiology or the numbers of previous in-hospital Direct laryngoscopy (DL)-guided or Video laryngoscopy (VL)-guided intubations in the year prior to the evaluated intubation, and FPS, overall success rate, overall time to intubation or subjective difficulty level of intubation (Table 3, Figs. 1 and 2)
Summary
Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative. Tracheal intubation remains the gold standard in emergency airway management [1]. It is known to be more difficult in the out-of-hospital setting than in an emergency department or operating room [2]. Direct laryngoscopy (DL) is a skill needing more than 150 successful intubations to achieve a reasonable overall success rate of 95% in the in-hospital setting [3, 4]. Compared with the in-hospital setting, personnel resources are limited in out-of-hospital emergency medicine (e.g., no back-up by a senior anaesthesist), and paramedics and emergency medical service (EMS) physicians have varying levels of experience in airway management. Improving safety, intubation success and especially first-pass intubation success (FPS) in these situations is imperative
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
