Is there a requirement for advanced airway management for trauma patients in the pre-hospital phase of care?

Abstract Background Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative. Methods We conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy. Results FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified. Conclusion Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.

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Association of Prehospital Advanced Airway Management With Neurologic Outcome and Survival in Patients With Out-of-Hospital Cardiac Arrest

JAMA ◽

10.1001/jama.2012.187612 ◽

2013 ◽

Vol 309 (3) ◽

pp. 257 ◽

Cited By ~ 212

Author(s):

Kohei Hasegawa ◽

Atsushi Hiraide ◽

Yuchiao Chang ◽

David F. M. Brown

Keyword(s):

Cardiac Arrest ◽

Airway Management ◽

Neurologic Outcome ◽

Advanced Airway ◽

Hospital Cardiac Arrest

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Airway Management for Trauma Patients With Potential Cervical Spine Injuries

Anesthesia & Analgesia ◽

10.1213/00000539-199110000-00019 ◽

1991 ◽

Vol 73 (4) ◽

pp. 471???482 ◽

Cited By ~ 88

Author(s):

Randolph H. Hastings ◽

James D. Marks

Keyword(s):

Cervical Spine ◽

Airway Management ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Spine Injuries

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Perception and success rate of using advanced airway management by hospital-based paramedics in the Kingdom of Saudi Arabia

British Paramedic Journal ◽

10.29045/14784726.2021.12.6.3.24 ◽

2021 ◽

Vol 6 (3) ◽

pp. 24-30

Author(s):

Amani Alenazi ◽

Bashayr Alotaibi ◽

Najla Saleh ◽

Abdullah Alshibani ◽

Meshal Alharbi ◽

...

Keyword(s):

Saudi Arabia ◽

Airway Management ◽

Success Rate ◽

Phase 1 ◽

Adult Patients ◽

Supraglottic Airway ◽

Future Research ◽

Phase 2 ◽

Advanced Airway ◽

Supraglottic Airway Devices

Objective: The study aimed to measure the success rate of pre-hospital tracheal intubation (TI) and supraglottic airway devices (SADs) performed by paramedics for adult patients and to assess the perception of paramedics of advanced airway management.Method: The study consisted of two phases: phase 1 was a retrospective analysis to assess the TI and SADs’ success rates when applied by paramedics for adult patients aged >14 years from 2012 to 2017, and phase 2 was a distributed questionnaire to assess paramedics’ perception of advanced airway management.Result: In phase 1, 24 patients met our inclusion criteria. Sixteen (67%) patients had TI, of whom five had failed TI but then were successfully managed using SADs. The TI success rate was 69% from the first two attempts compared to SADs (100% from first attempt). In phase 2, 63/90 (70%) paramedics responded to the questionnaire, of whom 60 (95%) completed it. Forty-eight (80%) paramedics classified themselves to be moderately or very competent with advanced airway management. However, most of them (80%) performed only 1‐5 TIs or SADs a year.Conclusion: Hospital-based paramedics (i.e. paramedics who are working at hospitals and not in the ambulance service, and who mostly respond to small restricted areas in Saudi Arabia) handled few patients requiring advanced airway management and had a higher competency level with SADs than with TI. The study findings could be impacted by the low sample size. Future research is needed on the success rate and impact on outcomes of using pre-hospital advanced airway management, and on the challenges of mechanical ventilation use during interfacility transfer.

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Advanced Airway Management in the Neurologically Injured Patient

Intensive Care Medicine ◽

10.1007/978-1-4757-5548-0_64 ◽

2003 ◽

pp. 679-700

Author(s):

A. Gabrielli ◽

L. J. Caruso ◽

A. J. Layon

Keyword(s):

Airway Management ◽

Injured Patient ◽

Advanced Airway

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Advanced Airway Management and Use of Anesthetic Drugs

Prehospital Trauma Care ◽

10.1201/9780203908624.ch13 ◽

2001 ◽

Author(s):

Charles Smith ◽

Ron Walls ◽

David Lockey ◽

Herbert Kuhnigk

Keyword(s):

Airway Management ◽

Anesthetic Drugs ◽

Advanced Airway

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Abstract 168: Association Between Prehospital Advanced Airway Management for Pediatric Out-of-Hospital Cardiac Arrest and Survival

Circulation ◽

10.1161/circ.138.suppl_2.168 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Masashi Okubo ◽

Sho Komukai ◽

Junichi Izawa ◽

Koichiro Gibo ◽

Kosuke Kiyohara ◽

...

Keyword(s):

Cardiac Arrest ◽

Propensity Score ◽

Airway Management ◽

Patient Outcomes ◽

Odds Ratio ◽

Pediatric Patients ◽

Time Dependent ◽

Advanced Airway ◽

Hospital Cardiac Arrest ◽

Favorable Functional Outcome

Introduction: It is unclear whether prehospital advanced airway management (AAM: endotracheal intubation and supraglottic airway device placement) for pediatric patients with out-of-hospital cardiac arrest (OHCA) improves patient outcomes. Objective: To test the hypothesis that prehospital advanced airway management during pediatric OHCA is associated with patient outcomes. Methods: We conducted a secondary analysis of a nationwide, prospective, population-based OHCA registry in Japan. We included pediatric patients (<18 years) with OHCA in whom emergency medical services (EMS) personnel resuscitated and transported to medical institutions during 2014 and 2015. The primary outcome was one-month survival. Secondary outcome was one-month survival with favorable functional outcome, defined as cerebral performance category score 1 or 2. Patients who received AAM during cardiopulmonary resuscitation by EMS personnel at any given minute were sequentially matched with patients at risk of receiving AAM within the same minutes based on time-dependent propensity score calculated from a competing risk regression model in which we treated prehospital return of spontaneous circulation as a competing risk event. Results: We included 2,548 patients; 1,017 (39.9%) were infants (<1 year), 839 (32.9%) were children (1 year to 12 years), and 692 (27.2%) were adolescents. Of the 2,548, included patients, 336 (13.2%) underwent prehospital AAM during cardiac arrest. In the time-dependent propensity score matched cohort (n = 642), there were no significant differences in one-month survival (AAM: 32/321 [10.0%] vs. no AAM: 27/321 [8.4%]; odds ratio, 1.33 [95% CI, 0.80 to 2.21]) and one-month survival with favorable functional outcome (AAM: 6/321 [1.9%] vs. no AAM: 5/321 [1.6%]; odds ratio, 1.48 [95% CI, 0.41 to 5.40]). Conclusions: Among pediatric patients with OHCA, we found no associations between prehospital AAM and favorable patient outcomes.

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Abstract 284: Association of Neurological Outcome and Survival With Interventions by Bystander and Emergency Medical Service for Unwitnessed Out-of-Hospital Cardiac Arrest Patient; Results From the JCS-ReSS Study

Circulation ◽

10.1161/circ.138.suppl_2.284 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Chisato Okamoto ◽

Yoshio Tahara ◽

Atsushi Hirayama ◽

Satoshi Yasuda ◽

Teruo Noguchi ◽

...

Keyword(s):

Cardiac Arrest ◽

Airway Management ◽

Emergency Medical Service ◽

Neurological Outcome ◽

Medical Service ◽

Favorable Outcome ◽

Shockable Rhythm ◽

Advanced Airway ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: Although studies have shown that bystander cardiopulmonary resuscitation (CPR) in witnessed out-of-hospital cardiac arrest (OHCA) is associated with better neurological prognosis, whether bystander and Emergency Medical Service (EMS) interventions are associated with prognosis in unwitnessed OHCA patients is not fully elucidated. We aimed to investigate the prognostic importance of bystander and EMS interventions among unwitnessed OHCA patients in Japan. Methods and Results: This study was a nation-wide population-based observational study of OHCA in Japan from 2011 to 2015 based on data from the All-Japan Utstein Registry. The outcome measures were neurological outcome and survival at 30-day. The neurologically favorable outcome was defined as Glasgow-Pittsburgh cerebral performance category score 1 or 2. First, to investigate the effectiveness of bystander interventions, we included 105,655 unwitnessed cardiogenic OHCA patients (aged 18-80 years). Of these, 1,614 (1.5%) showed neurologically favorable outcome and 3,273 (3.1%) survived at 30-day. Multivariate logistic regression analysis adjusting for age, sex, geographical region, year and EMS response time showed that bystander CPR was associated with neurologically favorable outcome (adjusted odds ratio [aOR] 1.49, 95% CI 1.35-1.65, P<0.001). Additionally, to investigate the effectiveness of EMS interventions for patients with non-shockable rhythm, we examined 43,342 patients who were performed public CPR and had the initial rhythm of pulseless electrical activity (PEA) or asystole. Of these, 101 (0.2%) showed neurologically favorable outcome and 453 (1.0%) were survival at 30-day. Advanced airway management by EMS was negatively associated with neurologically favorable outcome (aOR 0.55, 95% CI 0.37-0.81, P=0.003) and administration of epinephrine by EMS was associated with survival (aOR 2.35, 95% CI 1.89-2.92, P<0.001). Conclusions: Among unwitnessed OHCA patients, bystander CPR was associated with neurologically favorable prognosis. For unwitnessed OHCA patients with non-shockable rhythm, epinephrine administration was associated with survival, but advanced airway management was negatively associated with neurological outcome.

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