P Rehospital R Apid-Sequence I Ntubation : A P Ilot T Raining P Rogram

Kaye, Kory; Frascone, Ralph J.; Held, Timothy

doi:10.1080/10903120390936842

Cited by 23 publications

(4 citation statements)

References 8 publications

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“…This, together with the overall first pass success rate of 87.9%, is among the higher end of such rates for non-physician RSI reported in the literature [2] , [7] , [8] , [9] , [10] . Only three studies involving paramedic RSI could be found with a higher success rate [2] , [9] , [10] . Only one of these reported a first-pass success rate, which was 81% [9] .…”

Section: Discussionmentioning

confidence: 51%

Student paramedic rapid sequence intubation in Johannesburg, South Africa: A case series

Stein

2017

African Journal of Emergency Medicine

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IntroductionPre-hospital rapid sequence intubation was introduced within paramedic scope of practice in South Africa seven years ago. Since then, little data has been published on this high-risk intervention as practiced operationally or by students learning rapid sequence intubation in the pre-hospital environment. The objective of this study was to describe a series of pre-hospital rapid sequence intubation cases, including those that South African University paramedic students had participated in.MethodsA University clinical learning database was searched for all endotracheal intubation cases involving the use of neuromuscular blockers between 1 January 2011 and 31 December 2015. Data from selected cases were extracted and analysed descriptively.ResultsData indicated that most patients were young adult trauma victims with a dominant injury mechanism of vehicle-related accidents. The majority of cases utilised ketamine and suxamethonium, with a low rate of additional paralytic medication administration. 63% and 72% of patients received post-intubation sedation and analgesia, respectively. The overall intubation success rate from complete records was 99.6%, with a first pass success rate of 87.9%. Students were successful in 92.4% of attempts with a first-pass success rate of 85.2%. Five percent of patients experienced cardiac arrest between rapid sequence intubation and hospital arrival.DiscussionStudents demonstrated a good intubation success and first pass-success rate. However, newly qualified paramedics require strict protocols, clinical governance, and support to gain experience and perform pre-hospital rapid sequence intubation at an acceptable level in operational practice. More research is needed to understand the low rate of post-intubation paralysis, along with non-uniform administration of post-intubation sedation and analgesia, and the 5% prevalence of cardiac arrest.

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Section: Discussionmentioning

confidence: 51%

Student paramedic rapid sequence intubation in Johannesburg, South Africa: A case series

Stein

2017

African Journal of Emergency Medicine

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“…States that allowed DAI or another form of medication-assisted intubation were also found to have had varying requirements for certification and additional training. Intense medical director oversight has been cited as key to the success of a prehospital DAI program along with intense training including animal laboratories and live intubations in an operating room 31 . States that required medical director sign-off and ongoing training may benefit from further study to assess success rates compared with states without these requirements.…”

Section: Discussionmentioning

confidence: 99%

Variation in Prehospital Protocols for Pediatric Respiratory Distress Management in the United States

et al. 2022

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Objective: This study aimed to compare statewide emergency medical services protocols for the management of pediatric respiratory distress. Methods:We performed a descriptive study of emergency medical services protocols for the management of pediatric respiratory distress in the United States, excluding those without model or mandatory protocols. We compared medication recommendations for specific disease processes, including asthma, croup, epiglottitis, anaphylaxis, generalized respiratory distress, intubation, and drug assisted intubation.Results: Thirty-four state protocols were included. All had protocols to address the management of pediatric respiratory distress. There was high agreement in albuterol use for bronchospasm and epinephrine use in anaphylaxis. Epinephrine was recommended in all anaphylaxis protocols, 27 croup protocols (79%), and 3 epiglottitis protocols (9%). Six states (18%) called for albuterol in patients with generalized respiratory distress. Steroid recommendations and indications had variance among states; 26 states (76%) allowed steroid use in patients with asthma, 19 states (56%) recommended steroid use in anaphylaxis, and 11 (32%) recommended steroid use in croup protocols. The route for steroid administration also varied among protocols. Five states (15%) allowed continuous positive airway pressure application in pediatric patients, whereas endotracheal intubation and rapid sequence intubations had varying requirements as well as recommendations for use. Twelve (35%) listed impending or current respiratory failure as an indication, whereas other states had specific markers, such as Glasgow Coma Scale or oxygen saturation, as indications.Conclusions: All included states had specific recommendations for the management of pediatric respiratory distress. There was consistency in recommendations for albuterol use for wheezing and epinephrine use for anaphylaxis. However, there was wide variability in other uses for epinephrine, steroid administration, continuous positive airway pressure use, and specific treatments for croup and epiglottitis. The findings of this study provide a base for important future evidence-based protocol developments and changes in prehospital pediatric respiratory distress treatment.

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“…Recent studies indeed support the idea that, for example, rapid sequence induction before endotracheal intubation can safely be administered by paramedics in the field [19-22]. Invasive airway management requires sufficient training of personnel and immediate availability of appropriate salvage airway devices [23] and monitoring [24].…”

Section: Must Out-of-hospital Intubation Be Performed By a Physician mentioning

confidence: 99%

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Brambrink

Koerner

2004

Crit Care

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Adequate oxygenation at all times is of paramount importance to the critically injured patient to avoid secondary damage. The role of endotracheal intubation in out-of-hospital advanced trauma life support, however, remains controversial. Initiated by a recent observational study, this commentary discusses risks and benefits associated with prehospital intubation, the required personnel and training, and ethical implications. Recent evidence suggests that comprehensive ventilatory care already initiated in the field and maintained during transport may require the presence of a physician or another adequately skilled person at the scene. Benefits of such as service need to be balanced against increased costs.

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P Rehospital R Apid-Sequence I Ntubation : A P Ilot T Raining P Rogram

Cited by 23 publications

References 8 publications

Student paramedic rapid sequence intubation in Johannesburg, South Africa: A case series

Student paramedic rapid sequence intubation in Johannesburg, South Africa: A case series

Variation in Prehospital Protocols for Pediatric Respiratory Distress Management in the United States

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