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2014 ; 42
(6
): 1372-8
Nephropedia Template TP
gab.com Text
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English Wikipedia
The process of prehospital airway management: challenges and solutions during
paramedic endotracheal intubation
#MMPMID24589641
Prekker ME
; Kwok H
; Shin J
; Carlbom D
; Grabinsky A
; Rea TD
Crit Care Med
2014[Jun]; 42
(6
): 1372-8
PMID24589641
show ga
OBJECTIVES: Endotracheal intubation success rates in the prehospital setting are
variable. Our objective was to describe the challenges encountered and corrective
actions taken during the process of endotracheal intubation by paramedics.
DESIGN: Analysis of prehospital airway management using a prospective registry
that was linked to an emergency medical services administrative database.
SETTING: Emergency medical services system serving King County, Washington,
2006-2011. Paramedics in this system have the capability to administer
neuromuscular blocking agents to facilitate intubation (i.e., rapid sequence
intubation). PATIENTS: A total of 7,523 patients more than 12 years old in whom
paramedics attempted prehospital endotracheal intubation. INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: An intubation attempt was defined as the
introduction of the laryngoscope into the patient's mouth, and the attempt
concluded when the laryngoscope was removed from the mouth. Endotracheal
intubation was successful on the first attempt in 77% and ultimately successful
in 99% of patients (7,433 of 7,523). Paramedics used a rapid sequence intubation
strategy on 54% of first attempts. Among the subset with a failed first attempt
(n = 1,715), bodily fluids obstructing the laryngeal view (50%), obesity (28%),
patient positioning (17%), and facial or spinal trauma (6%) were identified as
challenges to intubation. A variety of adjustments were made to achieve
intubation success, including upper airway suctioning (used in 43% of attempts
resulting in success), patient repositioning (38%), rescue bougie use (19%),
operator change (16%), and rescue rapid sequence intubation (6%). Surgical
cricothyrotomy (0.4%, n = 27) and bag-valve-mask ventilation (0.8%, n = 60) were
rarely performed by paramedics as final rescue airway strategies. CONCLUSIONS:
Airway management in the prehospital setting has substantial challenges. Success
can require a collection of adjustments that involve equipment, personnel, and
medication often in a simultaneous fashion.
|Adult
[MESH]
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Clinical Competence
[MESH]
|Emergency Medical Services/*methods/standards/statistics & numerical data
[MESH]
|Emergency Medical Technicians
[MESH]
|Humans
[MESH]
|Intubation, Intratracheal/instrumentation/*methods/statistics & numerical data
[MESH]
|Male
[MESH]
|Middle Aged
[MESH]
|Neuromuscular Blocking Agents/therapeutic use
[MESH]
|Prospective Studies
[MESH]
|Quality of Health Care/statistics & numerical data
[MESH]