scholarly journals The need for standardized data reporting for prehospital airway management

Critical Care ◽  
2011 ◽  
Vol 15 (2) ◽  
pp. 133 ◽  
Author(s):  
Daniel P Davis
Keyword(s):  
Airway Management ◽  
Data Reporting ◽  
Prehospital Airway Management

Factors Influencing Successful Intubation in the Prehospital Setting

1995 ◽  
Vol 10 (4) ◽  
pp. 259-264 ◽  
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.

An analysis of advanced prehospital airway management

2002 ◽  
Vol 23 (2) ◽  
pp. 183-189 ◽  
Author(s):  
Eileen M Bulger ◽  
Michael K Copass ◽  
Ronald V Maier ◽  
Jonathan Larsen ◽  
Justin Knowles ◽  
...  
Keyword(s):  
Airway Management ◽  
Prehospital Airway Management

Prehospital Airway Management in the Acutely Injured Patient

1998 ◽  
Vol 45 (2) ◽  
pp. 312-314 ◽  
Author(s):  
Thorsten G. Gerich ◽  
Ulf Schmidt ◽  
Volker Hubrich ◽  
H. Philipp Lobenhoffer ◽  
Harald Tscherne
Keyword(s):  
Airway Management ◽  
Injured Patient ◽  
Prehospital Airway Management

Prehospital airway management using the laryngeal tube

2014 ◽  
Vol 63 (7) ◽  
pp. 589-596 ◽  
Author(s):  
M. Bernhard ◽  
W. Beres ◽  
A. Timmermann ◽  
R. Stepan ◽  
C.-A. Greim ◽  
...  
Keyword(s):  
Airway Management ◽  
Laryngeal Tube ◽  
Prehospital Airway Management

scholarly journals Novel Technologies and Techniques for Prehospital Airway Management: An NAEMSP Position Statement and Resource Document

2022 ◽  
Vol 26 (sup1) ◽  
pp. 129-136
Author(s):  
Catherine R. Counts ◽  
Justin L. Benoit ◽  
Graham McClelland ◽  
James DuCanto ◽  
Lauren Weekes ◽  
...  
Keyword(s):  
Airway Management ◽  
Position Statement ◽  
Novel Technologies ◽  
Prehospital Airway Management

scholarly journals Prehospital Airway Management Training and Education: An NAEMSP Position Statement and Resource Document

2022 ◽  
Vol 26 (sup1) ◽  
pp. 3-13
Author(s):  
Maia Dorsett ◽  
Ashish R. Panchal ◽  
Christopher Stephens ◽  
Andra Farcas ◽  
William Leggio ◽  
...  
Keyword(s):  
Airway Management ◽  
Management Training ◽  
Position Statement ◽  
Training And Education ◽  
Prehospital Airway Management

scholarly journals Prehospital Airway Management: A Systematic Review

2021 ◽  
Author(s):  
Nancy Carney ◽  
Tamara Cheney ◽  
Annette M. Totten ◽  
Rebecca Jungbauer ◽  
Matthew R. Neth ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Neurological Function ◽  
Controlled Trials ◽  
Dynamic Nature ◽  
Randomized Controlled ◽  
Advanced Airway ◽  
First Pass ◽  
Management Approaches ◽  
Prehospital Airway Management

Objective. To assess the comparative benefits and harms across three airway management approaches (bag valve mask [BVM], supraglottic airway [SGA], and endotracheal intubation [ETI]) by emergency medical services in the prehospital setting, and how the benefits and harms differ based on patient characteristics, techniques, and devices. Data sources. We searched electronic citation databases (Ovid® MEDLINE®, CINAHL®, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus®) from 1990 to September 2020 and reference lists, and posted a Federal Register notice request for data. Review methods. Review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center Program methods guidance. Using pre-established criteria, studies were selected and dual reviewed, data were abstracted, and studies were evaluated for risk of bias. Meta-analyses using profile-likelihood random effects models were conducted when data were available from studies reporting on similar outcomes, with analyses stratified by study design, emergency type, and age. We qualitatively synthesized results when meta-analysis was not indicated. Strength of evidence (SOE) was assessed for primary outcomes (survival, neurological function, return of spontaneous circulation [ROSC], and successful advanced airway insertion [for SGA and ETI only]). Results. We included 99 studies (22 randomized controlled trials and 77 observational studies) involving 630,397 patients. Overall, we found few differences in primary outcomes when airway management approaches were compared. • For survival, there was moderate SOE for findings of no difference for BVM versus ETI in adult and mixed-age cardiac arrest patients. There was low SOE for no difference in these patients for BVM versus SGA and SGA versus ETI. There was low SOE for all three comparisons in pediatric cardiac arrest patients, and low SOE in adult trauma patients when BVM was compared with ETI. • For neurological function, there was moderate SOE for no difference for BVM compared with ETI in adults with cardiac arrest. There was low SOE for no difference in pediatric cardiac arrest for BVM versus ETI and SGA versus ETI. In adults with cardiac arrest, neurological function was better for BVM and ETI compared with SGA (both low SOE). • ROSC was applicable only in cardiac arrest. For adults, there was low SOE that ROSC was more frequent with SGA compared with ETI, and no difference for BVM versus SGA or BVM versus ETI. In pediatric patients there was low SOE of no difference for BVM versus ETI and SGA versus ETI. • For successful advanced airway insertion, low SOE supported better first-pass success with SGA in adult and pediatric cardiac arrest patients and adult patients in studies that mixed emergency types. Low SOE also supported no difference for first-pass success in adult medical patients. For overall success, there was moderate SOE of no difference for adults with cardiac arrest, medical, and mixed emergency types. • While harms were not always measured or reported, moderate SOE supported all available findings. There were no differences in harms for BVM versus SGA or ETI. When SGA was compared with ETI, there were no differences for aspiration, oral/airway trauma, and regurgitation; SGA was better for multiple insertion attempts; and ETI was better for inadequate ventilation. Conclusions. The most common findings, across emergency types and age groups, were of no differences in primary outcomes when prehospital airway management approaches were compared. As most of the included studies were observational, these findings may reflect study design and methodological limitations. Due to the dynamic nature of the prehospital environment, the results are susceptible to indication and survival biases as well as confounding; however, the current evidence does not favor more invasive airway approaches. No conclusion was supported by high SOE for any comparison and patient group. This supports the need for high-quality randomized controlled trials designed to account for the variability and dynamic nature of prehospital airway management to advance and inform clinical practice as well as emergency medical services education and policy, and to improve patient-centered outcomes.

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