Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service

Stephen Jm Sollid,Hans Lossius,Eldar Søreide

doi:10.1186/1757-7241-18-30

Abstract

BackgroundAnaesthesiologists are airway management experts, which is one of the reasons why they serve as pre-hospital emergency physicians in many countries. However, limited data are available on the actual quality and safety of anaesthesiologist-managed pre-hospital endotracheal intubation (ETI). To explore whether the general indications for ETI are followed and what complications are recorded, we analysed the use of pre-hospital ETI in severely traumatised patients treated by anaesthesiologists in a Norwegian helicopter emergency medical service (HEMS).MethodsA retrospective audit of prospectively registered data concerning patients with trauma as the primary diagnosis and a National Committee on Aeronautics score of 4 - 7 during the period of 1994-2005 from a mixed rural/urban Norwegian HEMS was performed.ResultsAmong the 1255 cases identified, 238 successful pre-hospital ETIs out of 240 attempts were recorded (99.2% success rate). Furthermore, we identified 47 patients for whom ETI was performed immediately upon arrival to the emergency department (ED). This group represented 16% of all intubated patients. Of the ETIs performed in the ED, 43 patients had an initial Glasgow Coma Score (GCS) < 9. Compared to patients who underwent ETI in the ED, patients who underwent pre-hospital ETI had significantly lower median GCS (3 (3-6) vs. 6 (4-8)), lower revised trauma scores (RTS) (3.8 (1.8-5.9) vs. 5.0 (4.1-6.0)), longer mean scene times (23 ± 13 vs. 11 ± 11 min) and longer mean transport times (22 ± 16 vs. 13 ± 14 min). The audit also revealed that very few airway management complications had been recorded.ConclusionsWe found a very high success rate of pre-hospital ETI and few recorded complications in the studied anaesthesiologist-manned HEMS. However, a substantial number of trauma patients were intubated first on arrival in the ED. This delay may represent a quality problem. Therefore, we believe that more studies are needed to clarify the reasons for and possible clinical consequences of the delayed ETIs.

Highlights

Anaesthesiologists are airway management experts, which is one of the reasons why they serve as pre-hospital emergency physicians in many countries
We identified 47 patients for whom endotracheal intubation (ETI) was performed immediately upon arrival to the emergency department (ED)
When comparing missions carried out by helicopter or rapid response vehicle (RRV) we found no significant difference in patient age, sex, NACA score, revised trauma scores (RTS) or Glasgow Coma Score (GCS)

Summary

Introduction

Anaesthesiologists are airway management experts, which is one of the reasons why they serve as pre-hospital emergency physicians in many countries. Limited data are available on the actual quality and safety of anaesthesiologist-managed pre-hospital endotracheal intubation (ETI). Recent studies [3,4,5] have, documented high failure rates and life-threatening complications with pre-hospital ETI. These high failure and complication rates have been linked to suboptimal airway management training and experience of the pre-hospital ALS provider [6]. To avoid these issues, Department of Research and Development, Norwegian Air Ambulance. There seems to be a general consensus on when pre-hospital ETI should be performed [1,2,10,11], limited data are available on the quality and safety of anaesthesiologist-managed pre-hospital ETI in trauma

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