Prehospital Airway Management in Iraq and Afghanistan: A Descriptive Analysis

Abstract

WARNING RISK OF CARDIAC ARREST FROM HYPERKALEMIC RHABDOMYOLYSIS There have been rare reports of acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death after the administration of succinylcholine to apparently healthy children who were subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne's muscular dystrophy. This syndrome often presents as peaked T-waves and sudden cardiac arrest within minutes after the administration of the drug in healthy appearing children (usually, but not exclusively, males, and most frequently 8 years of age or younger). There have also been reports in adolescents. Therefore, when a healthy appearing infant or child develops cardiac arrest soon after administration of succinylcholine not felt to be due to inadequate ventilation, oxygenation, or anesthetic overdose, immediate treatment for hyperkalemia should be instituted. This should include administration of intravenous calcium, bicarbonate, and glucose with insulin, with hyperventilation. Due to the abrupt onset of this syndrome, routine resuscitative measures are likely to be unsuccessful. However, extraordinary and prolonged resuscitative efforts have resulted in successful resuscitation in some reported cases. In addition, in the presence of signs of malignant hyperthermia, appropriate treatment should be instituted concurrently. Since there may be no signs or symptoms to alert the practitioner to which patients are at risk, it is recommended that the use of succinylcholine in children should be reserved for emergency intubation or instances where immediate securing of the airway is necessary, e.g. laryngospasm, difficult airway, full stomach, or for intramuscular use when a suitable vein is inaccessible (see PRECAUTIONS: Pediatric Use and DOSAGE AND ADMINISTRATION). This drug should be used only by individuals familiar with its actions, characteristics, and hazards. DESCRIPTION ANECTINE (succinylcholine chloride) is an ultra short-acting depolarizing-type, skeletal muscle relaxant for intravenous (IV) administration.

A mixed methods end-user assessment to determine the ideal supraglottic airway device for inclusion into the medic's aid bag

“…Recent data demonstrate high mortality associated with the need for airway interventions in this setting. 3,4 Optimized airway management is among the top 5 battlefield research and development priorities identified by the Committee on Tactical Combat Casualty Care, yet the challenge of airway management has evolved little during the recent conflicts. 5 Schauer et al 6 noted that medics lacked access to various devices recommended in Tactical Combat Casualty Care guidelines, including the Control-Cric, which limits the ability to interpret, and more importantly, apply the results of, quantitative studies.…”

“…These two studies establish the importance of airway management for mortality reduction in the prehospital combat setting. Recent data demonstrate high mortality associated with the need for airway interventions in this setting 3,4 . Optimized airway management is among the top 5 battlefield research and development priorities identified by the Committee on Tactical Combat Casualty Care, yet the challenge of airway management has evolved little during the recent conflicts 5 .…”

Ketamine Administration in Prehospital Combat Injured Patients With Traumatic Brain Injury: A 10-Year Report of Survival

“…Our model was based on factors that have been previously linked to poor outcomes (e.g. airway interventions) and the need for airway interventions as ketamine is frequently used as a sedative agent during rapid sequence intubation [16,17]. Significant variables were reported as odds ratios with 95% confidence intervals (OR, 95% CI).…”

A prospective, pragmatic non‐inferiority study of emergency intubation success with the single‐use i‐view versus standard reusable video laryngoscope

“…11 Previous studies have demonstrated that intubations remain the primary airway performed in the prehospital combat setting. 12,13 These findings suggest that better technology and training may be necessary for far-forward medical personnel to improve outcomes. This includes technology targeted at intubations, but also surgical airways and supraglottic airways.…”