Prehospital Intubations and Mortality: A Level 1 Trauma Center Perspective

Cobas, Miguel; Peña, Maria Alejandra De la; Manning, Ronald J.; Candiotti, Keith A.; Varon, Albert J.

doi:10.1213/ane.0b013e3181aa3063

Cited by 173 publications

(96 citation statements)

References 26 publications

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“…This situation can arise independent of location (pre-or in-hospital setting), [1][2][3] clinical expertise (medical technician, nurse, or physician), 4,5 or specialty (emergency medicine, anesthesiology, critical care medicine, or surgery). [6][7][8] The most recent American Society of Anesthesiologists' (ASA) "Practice Guidelines for Management of the Difficult Airway" designate surgical or percutaneous airway, jet ventilation, or retrograde intubation as invasive airway access procedures to secure the airway in both non-emergency and emergency situations.…”

Section: Résumémentioning

confidence: 99%

Comparing success rates of anesthesia providers versus trauma surgeons in their use of palpation to identify the cricothyroid membrane in female subjects: a prospective observational study

Hiller

Karni

Cai

et al. 2016

Can J Anesth/J Can Anesth

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Section: Résumémentioning

confidence: 99%

Comparing success rates of anesthesia providers versus trauma surgeons in their use of palpation to identify the cricothyroid membrane in female subjects: a prospective observational study

Hiller

Karni

Cai

et al. 2016

Can J Anesth/J Can Anesth

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“…Our study revealed that four of 554 trauma patients (0.72%) received ESA in emergency surgery settings (odds ratio: 28.9-144.1). In the field of emergency medicine, studies have found that 0.3-0.9% of trauma patients received CTY in pre-hospital or ER settings [3][4][5][6]. Severe facial injury patients received ESA more often than did patients with other types of trauma.…”

Section: Discussionmentioning

confidence: 99%

Surgical airways for trauma patients in an emergency surgical setting: 11 years’ experience at a teaching hospital in Japan

Ono¹,

Yokoyama²,

Matsumoto³

et al. 2013

J Anesth

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Purpose Airway management of trauma patients during emergency surgeries can be very difficult, and presents a challenge for anesthesiologists. Difficult airways are associated with emergency surgical airways (ESA), but little is known about ESA in the operating room. We conducted this study to clarify the present use of ESA for trauma patients in emergency surgery settings. MethodsWe performed a retrospective review of all trauma patients requiring emergency surgery under general anesthesia at our hospital from January 2002 to December 2012, and focused on ESA.Results During the study period, 15,654 trauma patients were treated at our hospital, of whom 554 (3.5%) required emergency surgery. Four of these (0.72%) received ESA as definitive airway management. Two patients with severe facial injury and distorted upper airways and one patient with penetrating neck trauma received open standard tracheostomies (OST). These three patients received OST as the initial approach to intubation. A fourth OST was performed after several unsuccessful attempts at endotracheal intubation. No cases were classified as "cannot ventilate, cannot intubate" (CVCI), and there were no complications associated with ESA. All cases had good outcomes.Statistical analysis revealed that patients with severe facial trauma (Abbreviated Injury Scale ≥ 3) received ESA at a significantly higher rate than others (p=0.015, Odds ratio: 14.1). ConclusionOne of the most important functions of anesthesiologists is risk management. We should recognize risks that can cause CVCI situations, and make proper clinical decisions, including 3 providing ESA, to assure patient safety.4

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“…ALS providers need repeated exposure to advanced interventions to maintain their skills [3]. Skill dilution has been an observed phenomenon in models with higher paramedic to population ratio, and some studies have shown a correlation between a smaller number of paramedics to BLS responders, and successful intubation rates [3][4][5][6].…”

Section: Ems Trainingmentioning

confidence: 99%

Background and Advantages of a Tiered EMS Response in a Large, Fire-Based EMS Model

Persse¹

2015

Health Care Current Reviews

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The uniform response (one that includes a paramedic) provides some advantages, most notably that there is always an advanced AbstractEmergency medical services (EMS) systems vary across country, state, and even county lines. Which model provides the most effective and safe care has been hotly debated. Some models employ a fire-based EMS response, whereas others are privately funded and are completely separate from other public responders. Response can be uniform or tiered, which means that either ALS units respond to every call or calls are triaged based on their severity and units are dispatched accordingly. This requires a sophisticated dispatch algorithm that screens for emergencies of highest priority. Persse et al. sought to determine the difference in survival in out-of-hospital ventricular fibrillation arrest between a tiered response EMS model and an all advanced life support (ALS) response model within the same system.

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Prehospital Intubations and Mortality: A Level 1 Trauma Center Perspective

Cited by 173 publications

References 26 publications

Comparing success rates of anesthesia providers versus trauma surgeons in their use of palpation to identify the cricothyroid membrane in female subjects: a prospective observational study

Comparing success rates of anesthesia providers versus trauma surgeons in their use of palpation to identify the cricothyroid membrane in female subjects: a prospective observational study

Surgical airways for trauma patients in an emergency surgical setting: 11 years’ experience at a teaching hospital in Japan

Background and Advantages of a Tiered EMS Response in a Large, Fire-Based EMS Model

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