Factors influencing emergency intubation in the pre-hospital setting—a multicentre study in the German Helicopter Emergency Medical Service

Abstract

Despite various factors increasing the difficulties in managing the airway in the field, definitive airway control by ETI seems to be safe practice.

A paramedic study comparing the use of the Airtraq®, Airway Scope and Macintosh laryngoscopes in simulated prehospital airway scenarios*

“…When managing the airway in the prehospital environment, the rescuer's position with respect to the patient can be less than optimal [23,24]. Although a patient should ideally be moved on to a trolley before intubation, this is often not possible, especially when cardiopulmonary resuscitation has commenced or due to patient entrapment [23]. A number of patient [25] and manikin studies [18,19,26] have evaluated the ease of use of videolaryngoscopes in difficult circumstances.…”

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

“…Field intubation procedures are associated with more difficulty and complications than in-hospital procedures because of a wide range of factors. [144][145][146][147][148][149][150] Further, prehospital intubation is not always available and the ability to perform this procedure safely varies among prehospital EMS personnel, with physicians having the highest success rates. [144][145][146][147][148][149][150][151] Prioritizing advanced airway management and spinal immobilization may also delay release and rescue procedures as well as make the trauma examination more difficult, both at the scene, during transport, and at admittance.…”

“…[144][145][146][147][148][149][150] Further, prehospital intubation is not always available and the ability to perform this procedure safely varies among prehospital EMS personnel, with physicians having the highest success rates. [144][145][146][147][148][149][150][151] Prioritizing advanced airway management and spinal immobilization may also delay release and rescue procedures as well as make the trauma examination more difficult, both at the scene, during transport, and at admittance. 13,96,152 Delayed definitive care can be detrimental for patients with non-neurological critical injuries, and importantly, also lead to neurological progression, because spinal injuries are often neurologically unstable, but biomechanically stable in the acute phase.…”

Prehospital Endotracheal Intubation: Elemental or Detrimental?

“…In the ensuing discussion, it will be delineated how several under-recognized confounding variables have a major impact on the performance of this skill and even related outcomes. These variables include non-intuitive factors, such as how the EMS providers are deployed or how they have been trained to ventilate [32][33][34][35][36][37][38][39][40][41][42][43][44]. These concepts and how they relate to the success of prehospital ETI for the critically ill and injured will be addressed in the rest of this article.…”