Pre-hospital advanced airway management by anaesthetist and nurse anaesthetist critical care teams: a prospective observational study of 2028 pre-hospital tracheal intubations

Gellerfors, Mikael; Fevang, Espen; Bäckman, Anders; Krüger, Andreas; Mikkelsen, Søren; Nurmi, Jouni; Rognås, Leif; Sandström, Erik; Skallsjö, Gabriel; Svensén, Christer; Gryth, Dan; Lossius, Hans Morten

doi:10.1016/j.bja.2017.12.036

Cited by 68 publications

(110 citation statements)

References 30 publications

(42 reference statements)

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“…This study is a subgroup analysis of data recorded in a prospective, observational multicentre study conducted in the Nordic countries between May 2015 and November 2016. The PHAST database (Pre‐hospital advanced airway management by anaesthetists and nurse anaesthetists critical care teams) was designed to investigate the success rates of pre‐hospital TI as well as the incidence of complications …”

Section: Methodsmentioning

confidence: 99%

Checklists in pre‐hospital advanced airway management

Klingberg

Kornhall

Gryth

et al. 2019

Acta Anaesthesiol Scand

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Background In pre‐hospital care, pre‐intubation checklists (PICL) are widely implemented as a safety measure and guidelines support their use. However, the true value of PICL among experienced airway providers is unknown. This study aims to explore possible benefits and disadvantages of PICL in the pre‐hospital setting. Methods We performed a subgroup analysis of a prospective, observational, multicentre study on pre‐hospital advanced airway management in the Nordic countries between May 2015 and November 2016. The original trial was designed to investigate the success rates of pre‐hospital tracheal intubations and the incidence of complications. Our study limited inclusion to drug assisted intubations performed by anaesthesiologists. Intubation success rates and complication rates were plotted against checklist use. Results We analyzed 588 pre‐hospital intubations for medical and traumatic emergencies. Overall, checklists were used in 60.5% of instances. Applying checklists was associated with increased success at first and second intubation attempts. There was no significant difference in the overall success rates (99.4% and 99.1%). Oesophageal misplacement was more common in the No‐PICL group (2.2% vs 0.3%) but otherwise the incidence of airway related complications did not differ between the groups. Scene time was significantly shorter in the No‐PICL group (23.6 vs 27.5 minutes). Conclusion In this retrospective study, checklist use correlated with fewer attempts at intubation when securing the airway. Despite this, we found no association between checklist use and the overall TI success rate or the incidence of serious adverse events. Scene times were shorter without PICL.

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Section: Methodsmentioning

confidence: 99%

Checklists in pre‐hospital advanced airway management

Klingberg

Kornhall

Gryth

et al. 2019

Acta Anaesthesiol Scand

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“…The success rate for intubation in the helicopter (FG) was high (98.4%), similar to the success rates of prehospital ETI performed by physicians in other studies. (Table 4) showing the difficulty of IFI, however, overall success rate did not differ between FG and GG [17].…”

Section: Discussionmentioning

confidence: 87%

Intubation during A Medevac Flight: Safety and Effect on The Total Prehospital Time in Helicopter Emergency Medical Service System

Maeyama

Naito

Guyette

et al. 2020

Preprint

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Introduction: Endotracheal intubation is an essential skill in emergency medicine requiring technical proficiency and sufficient preparation for a safe procedure. In the Helicopter Emergency Medical Service (HEMS), it is common to intubate the patient who needs an advanced airway prior to take-off. In-flight-intubation (IFI) is avoided because it is considered difficult due to environmental limitations of space, communication, and vibration. In contrast, IFI may shorten the total prehospital time since the procedure is conducted during the flight. We tested whether IFI can be performed safely and shorten transportation time. Methods: We conducted a retrospective cohort study with patients transported from Apr 2010 to Mar 2017 in a single center. We included patients ≥ 18 years who received prehospital intubation and excluded patients with emergent intubation at the scene. We divided the observational cohort into two groups. The Flight group (FG): included patients intubated during the flight. The Ground group (GG): included patients intubated prior to take-off. HEMS crews transported both groups. The primary outcome was the proportion of successful intubations. Secondary outcomes included total prehospital time and the incidence of complications such as hypoxia and hypotension. Result: We analyzed 376 patients during the study period. There were 192 cases in FG and 184 cases in GG. Intubation success rate did not differ between the two groups (FG vs GG: 98.4% vs 97.3%, p = 0.50). There were no differences in hypoxia (FG vs GG: 3.4% vs 4.2%, p = 1.00) or hypotension (FG vs GG: 5.1% vs 5.3%, p = 1.00) between two groups. Scene time was shorter in FG (FG vs GG: 7 min vs 14 min, p < 0.001), as was total prehospital time (FG vs GG: 33.5 min vs 40.0 min, p < 0.001). Conclusions: In-flight-intubation during HEMS could be safely performed without additional hypoxia or hypotension. In-flight-intubation by experienced providers shortened transportation time by an average of 7 minutes.

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“…First, a previous meta-analysis reported a similar rate of first-pass intubations between VL and direct laryngoscopy (DL) in pre-hospital settings or amongst experienced clinicians. 2 Conversely, Gellerfors and colleagues 1 demonstrated that the rate of first-pass intubations was higher using VL compared with that using DL amongst experienced clinicians during prehospital tracheal intubation. Although a discrepancy in results exists between these studies, Gellerfors and colleagues 1 should provide further explanation for this conflicting finding.…”

mentioning

confidence: 98%

“…EditordWe thank Hung 1 for his letter in response to our article and welcome the opportunity to respond. 2 All 12 services, except two anaesthesiologist-manned ambulance helicopters in Norway, carried videolaryngoscopes (McGrath ® , C-MAC ® , Glidescope ® , or Airtraq ® ). 2 The decision to use videolaryngoscopy was at the discretion of the airway provider.…”

mentioning

confidence: 99%

“…2 All 12 services, except two anaesthesiologist-manned ambulance helicopters in Norway, carried videolaryngoscopes (McGrath ® , C-MAC ® , Glidescope ® , or Airtraq ® ). 2 The decision to use videolaryngoscopy was at the discretion of the airway provider. Videolaryngoscopy was used on the first tracheal intubation attempt in 41.6% of patients, and was associated with a higher first-pass success rate compared with direct laryngoscopy (92.9 vs 78.6%, P<0.01).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Pre-hospital advanced airway management: is quality improvement possible? Comment on Br J Anaesth 2018; 120: 1103–9

Hung

2019

British Journal of Anaesthesia

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MacLennan DH. Caffeine and halothane sensitivity of intracellular Ca 2þ release is altered by 15 calcium release channel (ryanodine receptor) mutations associated with malignant hyperthermia and/or central core disease. J Biol Chem 1997; 272: 26332e9 8. Allen GC, Larach MG, Kunselman AR. The sensitivity and specificity of the caffeine-halothane contracture test: a report from the North American malignant hyperthermia registry. The North American malignant hyperthermia registry of MHAUS.

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Pre-hospital advanced airway management by anaesthetist and nurse anaesthetist critical care teams: a prospective observational study of 2028 pre-hospital tracheal intubations

Abstract: NCT 02450071.

Cited by 68 publications

References 30 publications

Checklists in pre‐hospital advanced airway management

Checklists in pre‐hospital advanced airway management

Intubation during A Medevac Flight: Safety and Effect on The Total Prehospital Time in Helicopter Emergency Medical Service System

Pre-hospital advanced airway management: is quality improvement possible? Comment on Br J Anaesth 2018; 120: 1103–9

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