Field Airway Management Disasters

Abstract

half century ago, a patient with impaired ventilation was at high riskofimminentdeath.Successfulairwaymanagementprofoundlyreducestherisk of morbidity and mortality in a severely injured or ill patient.Unsuccessful airway management kills patients. Studies have questionedthe usefulness of endotracheal intubation by relatively inexperiencedrescuers because of its deadly complications (1,2). The impressive studyfrom Timmermann et al. (3) reveals similarly catastrophic disasters afterintubation in the field, as detected by emergency medical service (EMS)physicians arriving by helicopter and performing laryngoscopy uponarrival at the scene to verify endotracheal tube position. Although briefand rapidly detected esophageal intubation may not cause harm, sevenpatients with spontaneous circulation on initial examination developedasystole after esophageal intubation. This suggests iatrogenic hypoxiaresulting in cardiac arrest. We can only assume that the steps required todetect esophageal intubation were either incorrectly performed or com-pletely omitted in these cases.Unfortunately, these cases from Go¨ttingen, Germany are not isolatedincidents of bad luck. After we published eight cases of catastrophicairway management (4), another five cases quickly surfaced, suggestingthat these potentially deadly problems are common.