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The process of prehospital airway management: challenges and solutions during paramedic endotracheal intubation.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Prekker, Matthew E. Kwok, Heemun Shin, Jenny Carlbom, David Grabinsky, Andreas Sherman, Lawrence D. |
| Copyright Year | 2014 |
| Abstract | OBJECTIVES Endotracheal intubation success rates in the prehospital setting are variable. Our objective was to describe the challenges encountered and corrective actions taken during the process of endotracheal intubation by paramedics. DESIGN Analysis of prehospital airway management using a prospective registry that was linked to an emergency medical services administrative database. SETTING Emergency medical services system serving King County, Washington, 2006-2011. Paramedics in this system have the capability to administer neuromuscular blocking agents to facilitate intubation (i.e., rapid sequence intubation). PATIENTS A total of 7,523 patients more than 12 years old in whom paramedics attempted prehospital endotracheal intubation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS An intubation attempt was defined as the introduction of the laryngoscope into the patient's mouth, and the attempt concluded when the laryngoscope was removed from the mouth. Endotracheal intubation was successful on the first attempt in 77% and ultimately successful in 99% of patients (7,433 of 7,523). Paramedics used a rapid sequence intubation strategy on 54% of first attempts. Among the subset with a failed first attempt (n = 1,715), bodily fluids obstructing the laryngeal view (50%), obesity (28%), patient positioning (17%), and facial or spinal trauma (6%) were identified as challenges to intubation. A variety of adjustments were made to achieve intubation success, including upper airway suctioning (used in 43% of attempts resulting in success), patient repositioning (38%), rescue bougie use (19%), operator change (16%), and rescue rapid sequence intubation (6%). Surgical cricothyrotomy (0.4%, n = 27) and bag-valve-mask ventilation (0.8%, n = 60) were rarely performed by paramedics as final rescue airway strategies. CONCLUSIONS Airway management in the prehospital setting has substantial challenges. Success can require a collection of adjustments that involve equipment, personnel, and medication often in a simultaneous fashion. |
| Starting Page | 813 |
| Ending Page | 814 |
| Page Count | 2 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://www.emsonline.net/assets/QI/2015-CCM-Manuscript.pdf |
| PubMed reference number | 24589641v1 |
| Alternate Webpage(s) | https://doi.org/10.1097/CCM.0000000000000213 |
| DOI | 10.1097/CCM.0000000000000213 |
| Journal | Critical care medicine |
| Volume Number | 42 |
| Issue Number | 6 |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Airway Management Attempt Emergency medical service Intubation Intubation, Intratracheal Laryngeal Prosthesis Laryngoscopes Liquid substance Ninety Nine Patients Reactive airway disease Registries Repositioning (procedure) Respiration Solutions Spinal Muscular Atrophy Subgroup Suction drainage |
| Content Type | Text |
| Resource Type | Article |
