Impact of Operator Medical Specialty on Endotracheal Intubation Rates in Prehospital Emergency Medicine—A Retrospective Cohort Study

Abstract

Prehospital endotracheal intubation (ETI) can be challenging, and the risk of complications is higher than in the operating room. The goal of this study was to compare prehospital ETI rates between anaesthesiologists and non-anaesthesiologists. This retrospective cohort study compared prehospital interventions performed by either physicians from the anaesthesiology department (ADP) or physicians from another department (NADP, for non-anaesthesiology department physicians). The primary outcome was the prehospital ETI rate. Overall, 42,190 interventions were included in the analysis, of whom 68.5% were performed by NADP. Intubation was attempted on 2797 (6.6%) patients, without any difference between NADPs and ADPs (6.5 versus 6.7%, p = 0.555). However, ADPs were more likely to proceed to an intubation when patients were not in cardiac arrest (3.4 versus 3.0%, p = 0.026), whereas no difference was found regarding cardiac arrest patients (65.2 versus 67.7%, p = 0.243) (p for homogeneity = 0.005). In a prehospital physician-staffed emergency medical service, overall ETI rates did not depend on the frontline operator’s medical specialty background. ADPs were, however, more likely to proceed with ETI than NADPs when patients were not in cardiac arrest. Further studies should help to understand the reasons for this difference.

Factors associated with tracheal intubation–related complications in the prehospital setting: a prospective multicentric cohort study

“…Emergency intubation is routinely performed in the prehospital setting [1]. Airway management in the prehospital setting has substantial challenges, such as hostile environment or lack of technical support in case of first-attempt intubation failure, and inherent risk of complications, such as hypoxemia, aspiration or esophageal intubation [2][3][4].…”

“…In such conditions, tracheal intubation without delay is considered the gold standard for securing the airways [2]. However, in the prehospital setting, emergency physicians have to deal with unexpected difficulties such as hostile environments, uncomfortable positions, or limited equipment and human resources [1,2]. Standardized procedures of sedation [i.e.…”

“…On the prehospital field, airway management is often mandatory in emergency situations [1]. In such conditions, tracheal intubation without delay is considered the gold standard for securing the airways [2].…”