Procedural experience with out-of-hospital endotracheal intubation*

Wang, Henry E.; Kupas, Douglas F.; Hostler, David; Cooney, Robert; Yealy, Donald M.; Lave, Judith R.

doi:10.1097/01.ccm.0000171208.07895.2a

Cited by 117 publications

(63 citation statements)

References 20 publications

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“…Finally, although ETI is viewed as life-saving and common in EMS systems, most paramedics do not perform it frequently. 2 Given these factors, there is great potential for adverse outcomes and errors during ETI-for example, inadvertent oxygen desaturation, heart rhythm disturbances, breathing tube dislodgment, and unrecognized tube misplacement. 3 For this paper we sought to identify the prevalence of ETI errors and their associations with patient and EMS system characteristics.…”

mentioning

confidence: 99%

Paramedic Intubation Errors: Isolated Events Or Symptoms Of Larger Problems?

Wang¹,

Lave²,

Sirio³

et al. 2006

Health Affairs

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100

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Paramedics provide life-saving emergency medical care to patients in the outof-hospital setting, but only selected emergency interventions have proved to be safe or effective. Endotracheal intubation (the insertion of an emergency breathing tube into the trachea) is an important and high-profile procedure performed by paramedics. In our study population, we found that errors occurred in 22 percent of intubation attempts, with a frequency of up to 40 percent in selected ambulance systems. These findings indicate frequent errors associated with this life-saving technique. These events might be emblematic of larger issues in the structure and delivery of out-of-hospital emergency care. (EMS) to patients suffering life-threatening conditions such as cardiac arrest, respiratory failure, and major trauma. Paramedics often must perform endotracheal intubation (ETI), the insertion of a breathing tube into the trachea (windpipe), on these critically ill patients. Intubation is regarded as one of the most important EMS procedures and has been the standard of care in the United States for more than twenty years. 1 ETI is a complex procedure. Considerable skill is required to maneuver the breathing tube into the correct position. An improperly placed tube (for example, in the esophagus) can deprive the patient of oxygen and rapidly lead to death. Physician trainees in anesthesiology, critical care medicine, and emergency medicine spend many hours in controlled settings learning and practicing this difficult procedure. In contrast, paramedics undergo only a fraction of the training in ETI that physicians receive. Furthermore, paramedics perform ETI in uncontrolled, stress-

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mentioning

confidence: 99%

Paramedic Intubation Errors: Isolated Events Or Symptoms Of Larger Problems?

Wang¹,

Lave²,

Sirio³

et al. 2006

Health Affairs

Self Cite

100

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“…Second, prehospital endotracheal intubation by ALS has risks (31). Successful intubation requires high competency and practice, but in Pennsylvania, the median paramedic did only 1 intubation annually (33). Bag valve mask ventilation, commonly performed by BLS providers, may not pose the same threat of harm as intubation (11,(34)(35)(36)(37)(38).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies

Sanghavi¹,

Jena²,

Newhouse³

et al. 2016

Ann Intern Med

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“…Generally speaking, all operators think that their personal experience is the main reason for an optimal airway management (Wang et al 2005. However, in many cases, if the operator has low levels of experience and carries out a small number of intubations per year, an endotracheal intubation might be unfeasible (Thomas et al, 2010).…”

Section: Prehospital Airway Management: An Algorithmmentioning

confidence: 99%

“…On the basis of the best that has been published, it has been possible to create guidelines and a simple algorithm for prehospital airway management (Wang et al, 2005;Rich et al, 2004). The objective is to reduce errors during prehospital airway management, through rational, operative choices and in-depth patient evaluations.…”

Section: Prehospital Airway Management: An Algorithmmentioning

confidence: 99%