Abstract
BackgroundPre-hospital laryngoscopic endotracheal intubation (ETI) is potentially a life-saving procedure but is a technique difficult to acquire. This study aimed to obtain a recommendation for the number of times ETI should be practiced by constructing the learning curve for endotracheal intubation by paramedics, as well as to report the change in the frequency of complications possibly associated with intubation over the training period.MethodsUnder training conditions, 32 paramedics performed a total of 1,045 ETIs in an operating room. Trainees performed ETIs until they succeeded in 30 cases. For each patient, the number of laryngoscopic maneuvers and any complications potentially associated with ETI were recorded. We built a generalized logistic model to construct the learning curve for ETI and the frequency of complications.ResultsDuring the training on the first 30 patients the rate of ETI success at the first attempt improved from 71% to 87%, but there was little improvement during the first 13 cases. The frequency of complications decreased from 53% to 31%. More laryngoscopic maneuvers and longer operation time increased complications.ConclusionsIt seems that 30 live experiences of performing an ETI is sufficient for obtaining a 90% ETI success rate, but there seems to be little benefit with fewer than 13 experiences. The frequency of complications remained at a high level even after the training. It is desirable to conduct a more detailed and rigorous evaluation of the benefit of pre-hospital ETI by controlling for the skill level of paramedics.
Highlights
Pre-hospital laryngoscopic endotracheal intubation (ETI) is potentially a life-saving procedure but is a technique difficult to acquire
The objective of this study was to assess the efficacy of the training program from the following two points of view: (i) How much does the success rate of ETI improve over the course of the 30 live experiences? (ii) How much does the frequency of complications possibly associated
The National Standard Paramedic Curriculum in the US recommends that paramedic students perform at least five live endotracheal intubations [10], but the learning curve in Figure 1 suggests that five experiences are insufficient since we found that there is no significant learning up to 13 experiences and learning is fastest at around 19 experiences
Summary
Pre-hospital laryngoscopic endotracheal intubation (ETI) is potentially a life-saving procedure but is a technique difficult to acquire. This study aimed to obtain a recommendation for the number of times ETI should be practiced by constructing the learning curve for endotracheal intubation by paramedics, as well as to report the change in the frequency of complications possibly associated with intubation over the training period. In Japan, until 2004 only medical doctors were legally allowed to perform an endotracheal intubation on patients. In 2004, the Japanese Ministry of Health, Labour and Welfare legalized pre-hospital endotracheal intubation (ETI) by paramedics who have successfully completed a standardized training program, which consists of learning the theoretical aspects of ETI from a lecture and a video, practicing on a mannequin and 30 live experiences of intubation in an operating room.
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