Paramedic rapid sequence intubation in patients with non-traumatic coma

Bernard, Stephen; Smith, Karen; Porter, Robert; Jones, Colin; Gailey, A; Cresswell, Ben; Cudini, Daniel; Hill, Susan; Moore, Brendan; Clair, Toby St

doi:10.1136/emermed-2013-202930

Cited by 11 publications

(13 citation statements)

References 16 publications

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“…). The seven studies that were not suitable for prevalence‐of‐intubation pooling had cohorts that consisted entirely of those that were intubated, making a calculation of prevalence impossible . A comprehensive listing of the 46 articles with a description of study characteristics, prevalence‐bias assessment, and intubation prevalence are shown in Table S1 …”

Section: Resultsmentioning

confidence: 99%

“…These survival differences might be related to varying levels of illness severity between these pathologies, with haemorrhagic strokes having poorer prognosis compared to toxidromes and seizures. Some question the value of routinely intubating seizures and toxidromes in the emergency setting …”

Section: Discussionmentioning

confidence: 99%

“…Since most studies included here were ED based, it follows that most intubation could be RSI. RSI is also frequently used by out‐of‐hospital emergency services …”

Section: Discussionmentioning

confidence: 99%

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Review article: Emergency endotracheal intubation in non‐traumatic brain pathologies: A systematic review and meta‐analysis

Fouche

Stein

Jennings

et al. 2019

Emerg Medicine Australasia

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Endotracheal intubation is an advanced airway procedure performed in the ED and the out-ofhospital setting for acquired brain injuries that include non-traumatic brain pathologies such as stroke, encephalopathies, seizures and toxidromes. Controlled trial evidence supports intubation in traumatic brain injuries, but it is not clear that this evidence can be applied to nontraumatic brain pathologies. We sought to analyse the impact of emergency intubation on survival in non-traumatic brain pathologies and also to quantify the prevalence of intubation in these pathologies. We conducted a systematic literature search of Medline, Embase and the Cochrane Library. Eligibility, data extraction and assessment of risk of bias were assessed independently by two reviewers. A bias-adjusted metaanalysis using a quality-effects model pooled prevalence of intubation in non-traumatic brain pathologies. Forty-six studies were included in this systematic review. No studies were suitable for meta-analysis the primary outcome of survival. Thirtynine studies reported the prevalence of intubation in non-traumatic brain pathologies and a meta-analysis showed that emergency intubation was used in 12% (95% CI 0-33) of pathologies. Endotracheal intubation was used commonly in haemorrhagic stroke 79% (95% CI 47-100) and to a lesser extent for seizures 18% (95% CI 10-27) and toxidromes 25% (95% CI 6-48). This systematic review shows that there is no high-quality clinical evidence to support or refute emergency intubation in non-traumatic brain pathologies. Our analysis shows that intubation is commonly used in non-traumatic brain pathologies, and the need for rigorous evidence is apparent.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Review article: Emergency endotracheal intubation in non‐traumatic brain pathologies: A systematic review and meta‐analysis

Fouche

Stein

Jennings

et al. 2019

Emerg Medicine Australasia

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“…The authors reported p = 0.046, using a Pearson Chi‐squared test and the full Conclusion in the Abstract was “In adults with severe TBI, prehospital RSI by paramedics increases the rate of favourable neurologic outcome at 6 months compared with intubation in the hospital.” The absence of statistical significance for the primary outcome and all other secondary outcomes were not mentioned in the Conclusion. Subsequently, the RSI protocol was implemented in Victoria for routine use by road‐based paramedics in all patients with coma (Glasgow Coma Score ≤ 9) of both traumatic and nontraumatic causes …”

Section: Examplesmentioning

confidence: 99%

Two‐tailed significance tests for 2 × 2 contingency tables: What is the alternative?

Prescott

2019

Statistics in Medicine

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Two‐tailed significance testing for 2 × 2 contingency tables has remained controversial. Within the medical literature, different tests are used in different papers and that choice may decide whether findings are adjudged to be significant or nonsignificant; a state of affairs that is clearly undesirable. In this paper, it is argued that a part of the controversy is due to a failure to recognise that there are two possible alternative hypotheses to the Null. It is further argued that, while one alternative hypothesis can lead to tests with greater power, the other choice is more applicable in medical research. That leads to the recommendation that, within medical research, 2 × 2 tables should be tested using double the one‐tailed exact probability from Fisher's exact test or, as an approximation, the chi‐squared test with Yates' correction for continuity.

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“…Bernard et al from Victoria, Australia found that 49% of all RSIs in their emergency medical service (EMS) are on patients with a non-traumatic coma such as stroke and seizures (based on paramedic diagnosis). 6 Non-traumatic brain pathologies (NTBP) is defined as an acquired brain injury (either permanent or transient) that includes brain tumours, meningitis, encephalitis, hypoxic/anoxic brain injury, stroke, arteriovenous malformations, tumours, aneurysms, brain haemorrhage, as well as brain injury due to diabetes, seizures and toxicity, metabolic conditions and alcohol and drug overdose. [7][8][9] Whilst the prevalence of RSI for non-traumatic coma has been examined, the prevalence and survival outcomes for NTBP patients receiving paramedic RSI needs quantification.…”

Section: Introductionmentioning

confidence: 99%

Survival in Out-of-hospital Rapid Sequence Intubation of Non-Traumatic Brain Pathologies

Fouche

Jennings

Smith

et al. 2017

Prehospital Emergency Care

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Paramedic rapid sequence intubation in patients with non-traumatic coma

Abstract: Paramedic RSI in patients with non-traumatic coma has a high procedural success rate. Further studies are required to determine whether this procedure improves outcomes.

Cited by 11 publications

References 16 publications

Review article: Emergency endotracheal intubation in non‐traumatic brain pathologies: A systematic review and meta‐analysis

Review article: Emergency endotracheal intubation in non‐traumatic brain pathologies: A systematic review and meta‐analysis

Two‐tailed significance tests for 2 × 2 contingency tables: What is the alternative?

Survival in Out-of-hospital Rapid Sequence Intubation of Non-Traumatic Brain Pathologies

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