Determinants of Success and Failure in Prehospital Endotracheal Intubation

Abstract

IntroductionThis study aimed to identify factors associated with successful endotracheal intubation (ETI) by a multisite emergency medical services (EMS) agency.MethodsWe collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth). We analyzed patient and EMS factors affecting ETI.ResultsDuring 12,527 emergent ambulance responses, 200 intubation attempts were made in 150 patients. Intubation was successful in 113 (75%). A crew with paramedics was more than three times as likely to achieve successful intubation as a paramedic/emergency medical technician-Basic crew (odds ratio [OR], 3.30; p=0.03). A small tube (≤7.0 inches) was associated with a more than 4-fold increased likelihood of successful ETI compared with a large tube (≥7.5 inches) (OR, 4.25; p=0.01). After adjustment for these features, compared with little or no view of the glottis, a partial or entire view of the glottis was associated with a nearly 13-fold (OR, 12.98; p=0.001) and a nearly 40-fold (OR, 39.78; p<0.001) increased likelihood of successful intubation, respectively.ConclusionSuccessful ETI was more likely to be accomplished when a paramedic was partnered with another paramedic, when some or all of the glottis was visible and when a smaller endotracheal tube was used.

Comparison of videolaryngoscopy and direct laryngoscopy by German paramedics during out-of-hospital cardiopulmonary resuscitation; an observational prospective study

“…On the other Hand there is valid data that VL improves FPS [13][14][15]. Moreover, data exist showing that the overall success rate of ETI by inexperienced physicians during CPR is significantly higher with VL than with DL [4,9,16]. During CPR with ongoing chest compression using VL for ETI might result in reduced interruption of chest compressions [17][18][19].…”

“…In the Anglo-American paramedic system, the success rates for prehospital ETI using DL are between 71 and 75% [4,5]. In contrast to Anglo-American paramedic system to For German paramedics, ETI during CPR is generally a rare event as the attending physician usually carries out the procedure.…”

Comparison of videolaryngoscopy and direct laryngoscopy by German paramedics during out-of-hospital cardiopulmonary resuscitation. An observational prospective study.

“…Current updated international recommendations for advanced airway management from the International Liaison Committee on Resuscitation (ILCOR) suggest supraglottic devices for adults with Out-of-hospital cardiac arrest (OHCA) in settings with a low intubation success rate (3). In case of less experienced providers they recommended mask ventilation or supraglottic devices in order to not interrupt chest compressions.In the Anglo-American paramedic system, the success rates for prehospital ETI using DL are between 71% and 75% (4,5). In contrast to Anglo-American paramedic system to For German paramedics, ETI during CPR is generally a rare event as the attending physician usually carries out the procedure.…”

Comparison of videolaryngoscopy and direct laryngoscopy by less experienced paramedics during out-of-hospital cardiopulmonary resuscitation. An observational prospective study.

“…In the Anglo-American paramedic system, the success rates for prehospital ETI using DL are between 71% and 75% [12,13]. For German paramedics, ETI during CPR is generally a rare event as the attending physician usually carries out the procedure.…”

“…Videolaryngoscopy is superior to DL when the first attempt at intubation has failed and is associated with a reduction in esophageal intubations [16,17]. Moreover, data exist showing that the success rate of intubation by inexperienced physicians during CPR is significantly higher with VL than with DL [17,18,19]. The advantage of using VL for endobronchial intubation during CPR might result in reduced interruption of chest compressions [20,21,22].…”