BJA Advance Access originally published online on November 25, 2005
British Journal of Anaesthesia 2006 96(1):67-71; doi:10.1093/bja/aei275
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Factors influencing emergency intubation in the pre-hospital setting—a multicentre study in the German Helicopter Emergency Medical Service
1 Department of Anaesthesiology and Intensive Care Medicine—HEMS ‘Christoph 22’, Federal Armed Forces Medical Center Ulm, Germany. 2 Department of Anaesthesiology and Intensive Care Medicine—HEMS ‘Christoph 23’, Federal Armed Forces Medical Center Koblenz, Germany. 3 Department of Anaesthesiology and Intensive Care Medicine—HEMS ‘Christoph 29’, Federal Armed Forces Medical Center Hamburg, Germany
* Corresponding author. E-mail: matthias.helm{at}extern.uni-ulm.de
Background. Definitive airway control by endotracheal intubation (ETI) is standard of care in pre-hospital airway management. However, there are specific factors that may influence and complicate ETI.
Methods. Prospective, descriptive study at three German Helicopter Emergency Medical Services (HEMS) over a 1-yr period. We examined the success and complication rate for field intubation performed by trauma anaesthetists.
Results. In 342 patients (9.3%) ETI was performed. The overall success rate was 100%; in 87.4% the first attempt was successful, whereas in 11.1% a second and in 1.5% a third ETI attempt was necessary. No patient required a surgical intervention. Limited access to the patient was found upon arrival at the scene in 20.2% of the patients and in 9.6% of the patients at the time of ETI attempt. An orotracheal ETI technique was used in all patients. In the patients in whom only one ETI attempt was necessary for successful intubation, the assessment of ETI conditions was rated ‘very good’ or ‘good’ in 94.7%, but in those requiring a second or third ETI attempt this was reduced to 68.6 and 20.0%, respectively. Difficulties encountered during ETI included blood (19.9%), vomit/debris (15.8%) and secretions (13.8%) in the upper airway; anatomical reasons (11.7%), patient position (9.6%) and surrounding conditions (9.1%), making laryngoscopy more difficult.
Conclusions. Despite various factors increasing the difficulties in managing the airway in the field, definitive airway control by ETI seems to be safe practice.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. Timmermann, S. G. Russo, W. H. Rosenblatt, C. Eich, J. Barwing, M. Roessler, and B. M. Graf Intubating laryngeal mask airway for difficult out-of-hospital airway management: a prospective evaluation Br. J. Anaesth., August 1, 2007; 99(2): 286 - 291. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. von Goedecke, H. Herff, P. Paal, V. Dorges, and V. Wenzel Field Airway Management Disasters Anesth. Analg., March 1, 2007; 104(3): 481 - 483. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Y Ellis, G. E Davies, J. Pearn, and D. Lockey Prehospital rapid-sequence intubation of patients with trauma with a Glasgow Coma Score of 13 or 14 and the subsequent incidence of intracranial pathology Emerg. Med. J., February 1, 2007; 24(2): 139 - 141. [Abstract] [Full Text] [PDF]
|
|
E-letters:
Read all E-letters
- Scene endotracheal intubation performed by trained physicians is safe and efficient
- Philippe G Meyer, et al.
- British Journal of Anaesthesia, 19 Dec 2005 [Full text]
- Prehospital Emergency intubations: Extended role of UK Trauma Anaesthetists.
- Sumit Kumar Jha, et al.
- British Journal of Anaesthesia, 19 Dec 2005 [Full text]