Training and experience are more important than the type of practitioner for intubation success

Abstract

A meta-analysis by Lossius and colleagues demonstrated a higher endotracheal intubation (ETI) success rate for physicians compared with nonphysicians [1]. We reanalysed the data from Lossius and colleagues to investigate the relationship between the clinicians’ levels of training and ETI success rates, utilising the ‘Overview of included studies’ spreadsheet published online as an additional fi le. We created a variable for a high level of ETI training taken from the ‘extensively trained’ description in the ‘EMS manning’ column. We assumed the physicians to also be highly trained in ETI, as they entirely comprised emergency physicians and anaesthesio logists. Our multivariate meta-regression analysis, adjusting for the training and the type of practitioners, found a 2% diff erence in intubation success (P = 0.12) between physicians and nonphysicians (Table 1), which was not statistically signifi cant. Rapid sequence induction was left out of the fi nal model, because all physicians utilised this induction and its inclusion would needlessly infl ate variance. Lossius and colleagues compared ETI success rates of highly trained anaesthesiologists and emergency physicians from northwestern Europe with paramedics and nurses from the rest of the world [1]. One study incorporated in their meta-analysis included rural basic emergency medical technicians with no previous ETI experience [2]. Perhaps unsurprisingly, the authors showed increased ETI success rates for highly trained physicians compared with such a varied group of nonphysicians. However, our re-analysis suggests that the diff ering level of ETI training between clinicians, not the type of clinician, might be more important for successful ETI.