Prehospital cardiopulmonary resuscitation of the critically injured patient

Prehospital Endotracheal Intubation: Elemental or Detrimental?

“…drug administration, interventions traditionally provided in the in-hospital setting by expert physician specialists [1][2][3][4][5][6][7][8][9]. Paramedic skill portfolios ranged from basic spinal immobilization and extremity splinting to the more advanced skills of electrocardiographic (EKG) interpretation, defibrillation attempts, ETI, i.v.…”

“…The skill of ETI had become the definitive airway control for most critically ill and injured patients, be they in the operating room, in the early phases of an intensive care unit (ICU) hospitalization, or in the out-of-hospital setting [2][3][4][5][6][7][8][9]11]. The presumed presence of significant physiological derangements (e.g., hypoxemia, hypercarbia, hypoperfusion) in cardiopulmonary arrest, head injury and hemorrhagic states made ETI an intuitive procedure to perform as soon as feasible in the critically ill and injured [4,5,9,11].…”

“…In addition, there were other clinical care imperatives (e.g., airway protection, ventilatory control, end-tidal carbon monoxide monitoring, drug administration and airway suctioning) that drove a strong philosophy that EMS personnel should provide a definitive airway as soon as possible in the out-of-hospital setting for cardiopulmonary arrest, severe trauma and other life-threatening emergencies [2][3][4][5][6][7][8][9]11]. Nevertheless, although these invasive skills were now being provided by paramedics and nurses, for the most part they were still being delegated under the direction of accountable physician supervisor experts in out-of-hospital care [12].…”

“…Nevertheless, although these invasive skills were now being provided by paramedics and nurses, for the most part they were still being delegated under the direction of accountable physician supervisor experts in out-of-hospital care [12]. Early studies conducted in EMS systems with intensive, expert physician supervision, comprehensive training programs and on-scene supervision of EMS personnel reported extremely high rates of successful ETI for both children and adults [2][3][4][5][6][7][8][13][14][15].…”

“…In most of these studies, success was defined not only by accurate anatomic placement of the endotracheal tube (ETT), but also by absence of significant complications [3][4][5][6][7]. Moreover, prehospital ETI was soon correlated with positive outcomes particularly in the most dire of circumstances [7,8,15].…”