Abstract
BackgroundDrug-free tracheal intubation has been a common intervention in the context of out-of-hospital cardiac arrest for many years, however its use by paramedics has recently been the subject of much debate. Recent international guidance has recommended that only those achieving high tracheal intubation success should continue to use it.MethodsWe conducted a retrospective service evaluation of all drug-free tracheal intubation attempts by specialist paramedics (critical care) from South East Coast Ambulance Service NHS Foundation Trust between 1st January and 31st December 2019. Our primary outcome was first-pass success rate, and secondary outcomes were success within two attempts, overall success, Cormack-Lehane grade of view, and use of bougie.ResultsThere were 663 drug-free tracheal intubations and following screening, 605 were reviewed. There was a first-pass success rate of 81.5%, success within two attempts of 96.7%, and an overall success rate of 98.35%. There were ten unsuccessful attempts (1.65%). Bougie use was documented in 83.4% on the first attempt, 93.5% on the second attempt and 100% on the third attempt,ConclusionSpecialist paramedics (critical care) are able to deliver drug-free tracheal intubation with good first-pass success and high overall success and are therefore both safe and competent at this intervention.
Highlights
Tracheal intubation (TI) is a common intervention in critical care medicine and is indicated for a number of reasons, including airway protection in comatose patients or those at risk of aspiration, facilitation of mechanical ventilation, and in anticipation of a deteriorating clinical course that will very likely lead to respiratory failure [15]
TI is used in the context of both prehospital emergency anaesthesia or without anaesthetic drugs in the context of out-of-hospital cardiac arrest (OHCA) – drug-free tracheal intubation (DF-TI)
Given supraglottic airway devices are so widely available, a recent consensus statement from the College of Paramedics [4, 5] in the United Kingdom (UK) recommended that only paramedics with ongoing education, training, and clinical governance should perform TI, a recommendation which is emphasised by Soar et al [26]
Summary
Background Tracheal intubation (TI) is a common intervention in critical care medicine and is indicated for a number of reasons, including airway protection in comatose patients or those at risk of aspiration, facilitation of mechanical ventilation, and in anticipation of a deteriorating clinical course that will very likely lead to respiratory failure [15]. TI is used in the context of both prehospital emergency anaesthesia or without anaesthetic drugs in the context of out-of-hospital cardiac arrest (OHCA) – drug-free tracheal intubation (DF-TI). Houghton Budd et al BMC Emergency Medicine (2021) 21:144 for over 30 years and is indicated when less invasive methods of airway care (such as supraglottic airway devices) are deemed suboptimal, there is ongoing debate about both its safety and efficacy [21]. Drug-free tracheal intubation has been a common intervention in the context of out-of-hospital cardiac arrest for many years, its use by paramedics has recently been the subject of much debate. Recent international guidance has recommended that only those achieving high tracheal intubation success should continue to use it
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