Prehospital Endotracheal Intubation: Elemental or Detrimental?

Pepe, Paul E.; Roppolo, Lynn P.; Fowler, Raymond L.

doi:10.1007/978-3-319-13761-2_12

Cited by 3 publications

(3 citation statements)

References 43 publications

(125 reference statements)

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“…Recent evidence suggests that intubation in the prehospital setting may be associated with increased morbidity and mortality, or at least no improvement in outcomes as compared to bag-valve-mask ventilation [ 16 - 17 ]. It may be the case that some complications of prehospital intubation might be obviated by increased training regarding ETT depth, although more research is needed.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Endotracheal Tube Depth in the Out-of-Hospital Setting

Lubin

Fox

Leroux

2021

Cureus

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Introduction Endobronchial intubation is a known complication of endotracheal intubation with significant associated morbidity and a reported incidence of up to 15%. In the out-of-hospital setting, paramedics must rely on bedside techniques to confirm appropriate endotracheal tube (ETT) depth. The present real-world practices of paramedics have not been described in this regard. Methods A multi-point survey was distributed to paramedics within the state of Pennsylvania. Participants were scored on the basis of their use of techniques to confirm ETT depth with the highest sensitivity to exclude endobronchial intubation. Results Four-hundred nine (409) responses from 111 emergency medical services (EMS) agencies were recorded. Participants were found to evaluate endotracheal tube depth via auscultation of bilateral breath sounds (91.7% of participants), visualization of the endotracheal tube as it advances 1-2 cm beyond the vocal cords (82.9%), observation of symmetrical chest rise (80.0%), and by securing the ETT at 21 and 23 cm at the incisors for women and men (18.6%). Experienced paramedics were more likely to use the 21/23 cm rule (p=0.039). Participants did not employ the cumulative use of these techniques (p < 0.001) as per a method that has been previously described to exclude endobronchial intubation with 100% sensitivity. Conclusion These data suggest that paramedics are not presently employing the most sensitive techniques to exclude endobronchial intubation. An educational initiative and protocol update may be beneficial.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Endotracheal Tube Depth in the Out-of-Hospital Setting

Lubin

Fox

Leroux

2021

Cureus

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“…3 One system factor may be the number of exposures that individual EMS personnel have with ETI attempts. 4 Repetitive exposure has been shown to positively correlate with ETI success. 5 Considering the low proportion of patients seen by EMS that require ETI, the rate of ETI exposures a single paramedic may have during a year is likely too low to maintain proficiency with the skill.…”

Section: Introductionmentioning

confidence: 99%

“…The polarized discussion in EMS literature about the usefulness and safety of ETI may be more a function of system-level variables rather than patient-level variables that are often scrutinized to make correlations between ETI usage and patient outcomes 3 . One system factor may be the number of exposures that individual EMS personnel have with ETI attempts 4 . Repetitive exposure has been shown to positively correlate with ETI success 5 .…”

Section: Introductionmentioning

confidence: 99%

Prehospital Airway Management Examined at Two Pediatric Emergency Centers

Tweed¹,

George

Greenwell³

et al. 2018

Prehosp. Disaster med.

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IntroductionRoutine advanced airway usage by Emergency Medical Services (EMS) has had conflicting reports of being the secure airway of choice in pediatric patients.Hypothesis/ProblemThe primary objective was to describe a pediatric cohort requiring airway management upon their arrival directly from the scene to two pediatric emergency departments (PEDs). A secondary objective included assessing for associations in EMS airway management and patient outcomes.MethodsRetrospective data from the health record were reviewed, including EMS reports, for all arrivals less than 18 years old to two PEDs who required airway support between May 2015 and July 2016. The EMS management was classified as basic (oxygen, continuous positive airway pressure [CPAP], or bag-valve-mask [BVM]) or advanced (supraglottic or endotracheal intubation [ETI]) based on EMS documentation. Outcomes included oxygenation as documented by receiving PED and hospital mortality.ResultsIn total, 104 patients with an average age 5.9 (SD=5.1) years and median EMS Glasgow Coma Scale (GCS) of nine (IQR 3-14) were enrolled. Basic management was utilized in 70% of patients (passive: n=49; CPAP: n=2; BVM: n=22). Advanced management was utilized in 30% of patients (supraglottic: n=4; ETI: n=27). Proper ETI placement was achieved in 48% of attempted patients, with 41% of patients undergoing multiple attempts. Inadequate oxygenation occurred in 18% of patients, including four percent of ETI attempts, nine percent of BVM patients, and 32% of passively managed patients. Adjusted for EMS GCS, medical patients undergoing advanced airway management experienced higher risk of mortality (risk-ratio [RR] 2.98; 95% CI, 1.18-7.56; P=.021).ConclusionWith exception to instances where ETI is clearly indicated, BVM management is effective in pediatric patients who required airway support, with ETI providing no definitive protective factors. Most of the patients who exhibited inadequate oxygenation upon arrival to the PED received only passive oxygenation by EMS.TweedJ, GeorgeT, GreenwellC, VinsonL.Prehospital airway management examined at two pediatric emergency centers. Prehosp Disaster Med. 2018;33(5):532–538.

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