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An Analysis of Invasive Airway Management in a Suburban Emergency Medical Services System

Published online by Cambridge University Press:  28 June 2012

Thomas J. Krisanda*
Affiliation:
The Department of Emergency Medicine, York Hospital, York, Pa.
David R. Eitel
Affiliation:
The Department of Emergency Medicine, York Hospital, York, Pa.
Dean Hess
Affiliation:
The Department of Research, York Hospital, York, Pa.
Robert Ormanoski
Affiliation:
The Department of Emergency Medicine, Memorial Hospital, York, Pa.
Robert Bernini
Affiliation:
The Department of Emergency Medicine, York Hospital, York, Pa.
Nancy Sabulsky
Affiliation:
The Department of Research, York Hospital, York, Pa.
*
Department of Emergency Medicine, York Hospital, 1001 South George Street, York, PA 17405USA

Abstract

Introduction:

Airway management is the most critical and potentially life-saving intervention performed by emergency medical service (EMS) providers. Invasive airway management often is required in non-cardiac-arrest patients who are combative or otherwise uncooperative. The success of prehospital invasive airway management in this patient population was evaluated.

Methods:

A retrospective review was undertaken of the records of all such patients requiring endotracheal intubation over a three-year period (1987–1989). The study population included 278 patients enrolled by five advanced life support (ALS) units serving a suburban population of 425,000. Field trip sheets were reviewed for diagnosis, intubation method and success, number of intubation attempts, provider experience, reasons for unsuccessful intubations, and complications.

Results:

A total of 394 invasive airway management attempts were performed on 278 patients. The overall successful intubation rate was 75% (41 % orotracheal, 52% nasotracheal, 7% other or unknown). The most common diagnoses were COPD and pulmonary edema (30%) and trauma (24%). Experienced providers were successful on the first attempt in 57% of cases compared to 50% by inexperienced providers (p=.24). Multiple intubation attempts were required in 33% of the patients. There was no statistically significant difference in success rates between the orotracheal and nasotracheal methods (p=.51). The most common reason for unsuccessful intubation was altered level of consciousness. Complications occurred with 7% of successful attempts and in 18% of unsuccessful attempts (p<.001). Forty-six percent of the patients who were not intubated successfully in the field and required intubation in the emergency department (ED) received a neuromuscular blocking agent prior to successful intubation.

Conclusion:

Prehospital providers can intubate a high but improvable proportion of non-cardiac-arrested patients by both the orotracheal and nasotracheal routes. The use of pharmacologic adjuncts to facilitate the prehospital intubation of selected, non-cardiac-arrested patients is a promising adjunct that needs further evaluation.

Type
Original Research
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1992

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References

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