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Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians.

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Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Lockey, D. Crewdson, K. Weaver, A. Davies, G.
Description	Country affiliation: United kingdom Author Affiliation: Lockey D ( London's Air Ambulance, The Helipad, Royal London Hospital, Whitechapel, London E1 1BB, UK School of Clinical Sciences, University of Bristol, Bristol, UK djlockey@hotmail.com.); Crewdson K ( London's Air Ambulance, The Helipad, Royal London Hospital, Whitechapel, London E1 1BB, UK.); Weaver A ( London's Air Ambulance, The Helipad, Royal London Hospital, Whitechapel, London E1 1BB, UK.); Davies G ( London's Air Ambulance, The Helipad, Royal London Hospital, Whitechapel, London E1 1BB, UK.)
Abstract	BACKGROUND: Effective airway management is a priority in early trauma management. Data on physician pre-hospital tracheal intubation are limited; this study was performed to establish the success rate for tracheal intubation in a physician-led system and examine the management of failed intubation and emergency surgical cricothyroidotomy in pre-hospital trauma patients. Failed intubation rates for anaesthetists and non-anaesthetists were compared. METHODS: A retrospective database review was conducted to identify trauma patients undergoing pre-hospital advanced airway management between September 1991 and December 2012. The success rate of tracheal intubation and the use and success of rescue techniques were established. Success rates of tracheal intubation by individuals and by speciality were recorded. RESULTS: The doctor-paramedic team attended 28 939 patients; 7256 (25.1%) required advanced airway management. A surgical airway was performed immediately, without attempted laryngoscopy, in 46 patients (0.6%). Tracheal intubation was successful in 7158 patients (99.3%). Rescue surgical airways were performed in 42 patients, seven had successful insertion of supraglottic devices, and two patients had supraglottic device insertion and a surgical airway. One patient breathed spontaneously with bag-valve-mask support during transfer. All rescue techniques were successful. Non-anaesthetists performed 4394 intubations and failed to intubate in 41 cases (0.9%); anaesthetists performed 2587 intubations and failed in 11 (0.4%) (P=0.02). CONCLUSIONS: This is the largest series of physician pre-hospital tracheal intubation; the success rate of 99.3% is consistent with other reported data. All rescue airways were successful. Non-anaesthetists were twice as likely to have to perform a rescue airway intervention than anaesthetists. Surgical airway rates reported here (0.7%) are lower than most other physician-led series (median 3.1%, range 0.1-7.7%).
File Format	HTM / HTML
ISSN	00070912
e-ISSN	14716771
Journal	British Journal of Anaesthesia
Issue Number	2
Volume Number	113
Language	English
Publisher	Oxford University Press
Publisher Date	2014-08-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Anesthesiology Airway Management Emergency Medical Services Intubation, Intratracheal Wounds And Injuries Therapy Adverse Effects Statistics & Numerical Data Allied Health Personnel Databases, Factual Manpower Patient Care Team Physicians Retrospective Studies Trachea Injuries Treatment Failure Observational Study
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine

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An observational study of intubation success rates and rescue airway techniques among 7256 pre-hospital physician intubations of trauma patients

An observational study of intubation success rates and rescue airway techniques among 7256 pre-hospital physician intubations of trauma patients

An observational study of intubation success rates and rescue airway techniques among 7256 pre-hospital physician intubations of trauma patients

Advanced airway management is necessary in prehospital trauma patients.

Prehospital intubations and mortality: a level 1 trauma center perspective. (Journal: Anesthesia & Analgesia Volume: 109 Issue: 2)

Emergency management of the trauma airway.

Multiple failed intubation attempts are associated with decreased success rates on the first rescue intubation in the emergency department: a retrospective analysis of multicentre observational data

Intubation bougie dissection of tracheal mucosa and intratracheal airway obstruction.

First-pass intubation success rate during rapid sequence induction of prehospital anaesthesia by physicians versus paramedics.

Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians.

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An observational study of intubation success rates and rescue airway techniques among 7256 pre-hospital physician intubations of trauma patients

An observational study of intubation success rates and rescue airway techniques among 7256 pre-hospital physician intubations of trauma patients

An observational study of intubation success rates and rescue airway techniques among 7256 pre-hospital physician intubations of trauma patients

Advanced airway management is necessary in prehospital trauma patients.

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Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians.