Prehospital Airway Management: A Systematic Review

Study Design: The present study is a systematic review of the literature. Objective: The goal of this study is to review our experience and the current literature on airway management techniques in maxillofacial trauma. Methods: Independent searches of the PubMed and MEDLINE databases were performed from January 1, 2019 to February 1, 2019. Articles from the period of 2008 to 2018 were collected. All studies which described both airway management and maxillofacial trauma using the Boolean method and relevant search term combinations, including “maxillofacial,” “trauma,” and “airway,” were considered. Results: A total of 452 relevant articles in total were identified. Articles meeting inclusion criteria by abstract review included 68 total articles, of which 16 articles were focused on airway management techniques for maxillofacial trauma in the general population and were deemed appropriate for inclusion in the literature review. Conclusions: Establishing an effective and stable airway in patients with maxillofacial trauma is of paramount concern. In both the acute setting and during delayed reconstruction, special considerations must be taken when securing a reliable airway in this patient population. The present article provides techniques for securing the airway and algorithms for utilization of these techniques, including both during the initial evaluation and the definitive operative management.

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Airway management education: simulation based training versus non-simulation based training-A systematic review and meta-analyses

BMC Anesthesiology ◽

10.1186/s12871-017-0313-7 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 17

Author(s):

Yanxia Sun ◽

Chuxiong Pan ◽

Tianzuo Li ◽

Tong J. Gan

Keyword(s):

Systematic Review ◽

Airway Management ◽

Management Education ◽

Simulation Based ◽

Meta Analyses

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Factors Influencing Successful Intubation in the Prehospital Setting

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00042138 ◽

1995 ◽

Vol 10 (4) ◽

pp. 259-264 ◽

Cited By ~ 56

Author(s):

James V. Doran ◽

Bartholomew J. Tortella ◽

Walter J. Drivet ◽

Robert F. Lavery

Keyword(s):

Airway Management ◽

Endotracheal Intubation ◽

Life Support ◽

Advanced Life Support ◽

High Volume ◽

Success Rates ◽

Structured Interviews ◽

Technical Problems ◽

Patients Âgés ◽

Prehospital Airway Management

AbstractObjective:To explore the determinants influencing oral/nasal endotracheal intubation (OETI/NETI) and determine which cognitive, therapeutic, and technical interventions may assist prehospital airway management.Design, Setting, and Participants:Prospective review of run reports and structured interviews of paramedics involved in OETI/NETI attempts were conducted in a high-volume, inner-city, advanced life support (ALS) system during an eight-month period (July 1991 to February 1992). Data were abstracted from run reports, and paramedics were asked in structured interviews to describe difficulties in OETI/NETI attempts.Results:Of 236 patients studied, 88% (208) were intubated successfully. Success/failure rate was not related statistically to patients' ages (p = 0. 78), medical or trauma complaint (89% vs 85%, p = 0.35), oral versus nasal route (88% vs 85%, p = 0.38), care time (scene + transport times: success, 18 minutes; failure, 20 minutes, p = 0.30), paramedic seniority (p = 0.13), or number of attempts per paramedic (p >0.05). Increased level of consciousness (LOC) was associated with decreased success rate (p = 0.04). Paramedics reported difficulties in endotracheal intubation (ETI) attempts in 110 (46.6%) of patients. Factors reported to increase ETI difficulty were: 1) technical problems (35.6%); 2) mechanical problems (15.6%); and 3) combative patients (12.7%).Conclusions:Oral endotracheal intubation and NETI success rates identified in this study are similar to those described in the literature, although innovative strategies could be used to facilitate prehospital airway management. Many of the factors found to increase ETI difficulty could be ameliorated by the administration of paralytic agents, that is, for combative patients. Focused training in cadaver and animal labs coupled with recurrence training in the operating suites should be used on a regular basis to decrease difficulties in visualization. Interventions directed at alleviating mechanical difficulties that should be explored include new-to-the-field techniques, such as retrograde intubation, fiber-optic technology, and surgical tracheal access.

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