Predictors for Prehospital First-Pass Intubation Success in Germany.

Lukas Reinert,Wilhelm Behringer,Jasmin Arrich,Steffen Herdtle,Christian Hohenstein

doi:10.3390/jcm11030887

Abstract

(1) Background: Endotracheal intubation in the prehospital setting is an important skill for emergency physicians, paramedics, and other members of the EMS providing airway management. Its success determines complications and patient mortality. The aim of this study was to find predictors for first-pass intubation success in the prehospital emergency setting. (2) The study was based on a retrospective analysis of a population-based registry of prehospital advanced airway management in Germany. Cases of endotracheal intubation by the emergency medical services in the cities of Tübingen and Jena between 2016 and 2019 were included. The outcome of interest was first-pass intubation success. Univariate and multivariable regression analysis were used to analyse the influence of predefined predictors, including the characteristics of patients, the intubating staff, and the clinical situation. (3) Results: A total of 308 patients were analysed. After adjustment for multiple confounders, the direct vocal cord view, a less favourable Cormack–Lehane classification, the general practitioner as medical specialty, and location and type of EMS were independent predictors for first-pass intubation success. (4) Conclusions: In physician-led emergency medical services, the laryngoscopic view, medical specialty, type of EMS, and career level are associated with FPS. The latter points towards the importance of experience and regular training in endotracheal intubation.

Highlights

Endotracheal intubation (ETI), either by direct laryngoscopy or by videolaryngoscopy, is still considered the gold standard for securing the airway [1–5]
Of 388 patients initially documented in the observation period, we excluded 36 intubated with a primarily placed supraglottic airway, eight where the mode of intubation was not clear, and a further 36 where it was not reported if they had first-pass intubation success (FPS)
Predictors associated with a higher FPS in the univariate analysis were a direct vocal cord view, a more favourable CL grade, the use of suction, and the type and location of the EMS

Summary

Introduction

Endotracheal intubation (ETI), either by direct laryngoscopy or by videolaryngoscopy, is still considered the gold standard for securing the airway [1–5]. It is one of the most important skills to be mastered by the members of the EMS team [2,6]. In the out-of-hospital setting, the procedures itself are even more challenging, as information on the patient, resources, space, and time are limited. Other life-saving procedures take place at the same time and further complicate the process of securing the airway. Failed first-pass intubation success (FPS) is associated with an increasing number of adverse events, such as desaturation and airway injury, and with higher levels of patient mortality [2,9]

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Discussion

Conclusion