>Pre-hospital Airway Management – the bottom line

Study review of recent Airway World Webinar.

Reviewed by David Lewis and Jay Mekwan

The study: Retrospective Data Review conducted in Australia investigating rates of successful RSI by intensive care paramedics.

Rationale: Controversial whether RSI should be completed pre-hospital as unsuccessful attempts can result in patient complications.

Results: First pass success rate of 89.4% with low rates of complications – hypoxia (1.3%) and hypotension (5.2%).

Bottom line:  Appropriately trained air transport paramedics can perform RSI pre-hospital with high levels of success.

 

The study: Retrospective review of a global database tracking critical care transport program. Looked at first pass success attempts at tracheal intubation in the field

Rationale: Critical care transport teams are the first point of critical care contact for acutely unwell patients. Tracheal intubation can be a lifesaving intervention performed while transporting to a tertiary care center.

Results: First attempt intubation success was higher in adult focused critical care transport paramedics, regardless of the age of the patient (>86%).

Bottom Line: Experience may be a significant factor for intubation success. Experienced intubators have better success rates in all patient age groups.

 

The study: Retrospective chart review of air medical patient records where cricothyrotomy was performed to assess frequency, success and technique.

Rationale: When all other airway maneuvers fail, cricothyrotomy is a potentially lifesaving skill.

The results: Performance of cricothyrotomy is rare (<1% of over 22,000 patients), but when performed had 100% success rate.

Bottom Line: Although a rarely performed skill, Helicopter Emergency Medicine Service providers can successfully perform cricothyrotomy when needed.

 

The study: Multicenter randomized clinical trial comparing outcomes in patients who were either intubated or bagged following out of hospital cardiorespiratory arrest.

Rationale: Bag mask ventilation is an easier clinical technique to perform during CPR and previously reported as superior than intubation in terms of survival. Neurological outcomes at 28 days post arrest had not been reported.

Results: No difference in rates of survival or neurological at 28 days between bagged or intubated patients. Bag mask ventilation was associated with higher regurgitation rates and, in general, were more difficult airways to manage.

Bottom line: We don’t know if bag mask ventilation or intubation is superior. More research needed.

This post was copyedited by Mandy Peach

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