Endotracheal intubation and esophageal tracheal combitube insertion by regular ambulance attendants:: A comparative trial

Abstract

Objective Recent cardiac arrest resuscitation guidelines have recommended the esophageal tracheal Combitube (ETC) as an advanced airway management alternative for individuals who infrequently perform endotracheal intubation (ETI). This study attempted to analyze basic (nonparamedic) ambulance attendant success rates at ETI and ETC insertion as well as their continuing skill competency over time and whether ongoing practice on mannequins improved skill performance. Methods Three hundred fifty-seven adult patients in cardiorespiratory arrest were treated by 81 basic ambulance attendants. Original study design called for the analysis of two treatment options in three patient groups: ETC insertion, ETI insertion with mannequin practice (ETI-MP), and ETI insertion without mannequin practice (ETI-NMP). The main outcome measures were: (1) successful insertion and ventilation with ETC or ETI, assessed by receiving physicians; and (2) differences in successful insertion/ventilation between the MP and NMP groups. Results Successful insertion (intent-to-treat) for the ETI-NMP group was 70 of 111 (63%; 95% confidence interval [CI], 54–73%); ETI-MP success was 105 of 139 (76%; 95% CI, 67–84%); ETC-NMP success was 26 of 42 (62%; 95% CI, 49–75%); and ETC-MP success was 36 of 53 (68%; 95% CI, 54–82%). Continuing mannequin practice appeared to improve ETI success (as-treated): MP 75% versus NMP 61% (odds ratio, 2.1; 95% CI, 1.11–3.94). Conclusions There were similar rates of successful insertion/ventilation with the ETC and ETI. ETI insertion success was lower without mannequin practice. ETI skill erosion was partially mitigated by additional field experience.