title: Intubation success rates improve for an air medical program after implementing the use of neuromuscular blocking agents.
abstract: To determine whether the success rate for endotracheal intubation improves after implementing the use of neuromuscular blocking (NMB) agents in an air medical program, this retrospective study analyzed all patients requiring endotracheal intubation at two air medical programs (nurse/paramedic crews) over a 5-year period. Air medical program A, the control group, had employed NMB agents throughout the entire study period. Air medical program B, which did not use NMB agents from July 1, 1989 through June 30, 1992, implemented their use starting July 1, 1992. For program A, the overall intubation success rate was 93.5% (202 successful intubations in 216 patients) and the successful intubations/total attempts ratio was 0.67 (202 of 301). For program B, the overall intubation success rate improved from 66.7% (46 successful intubations in 69 patients) before NMB agent use to 90.5% (57 in 63) after NMB agent use (P = .001). The successful intubations/total attempts ratio increased from 0.36 (51 of 141) prior to NMB agent use to 0.48 (63 of 132) after NMB agent use (P = NS). In comparing the 92 patients who did not receive NMB agents to the 40 patients who did, the intubation success rate increased from 69.6% (64 of 92) to 97.5% (39 of 40) (P < .001) and the successful intubation/total attempts ratio increased from 0.36 (73 of 202) to 0.58 (41 of 71) (P = .007). With the use of NMB agents, program B's overall intubation success rate increased significantly, matching the results of program A.
authors.affiliation: Department of Emergency Medicine and Carolina Air Care, University of North Carolina, Chapel Hill 27599-7594, USA.
authors.forename: O J
authors.initials: OJ
authors.lastname: Ma
authors.forename: R B
authors.initials: RB
authors.lastname: Atchley
authors.forename: T
authors.initials: T
authors.lastname: Hatley
authors.forename: M
authors.initials: M
authors.lastname: Green
authors.forename: J
authors.initials: J
authors.lastname: Young
authors.forename: W
authors.initials: W
authors.lastname: Brady
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000328:Adult; D017732:Air Ambulances; D000771:Anesthesia, Intravenous; D000779:Anesthetics, Local / Q000008:administration & dosage; D001285:Atropine / Q000008:administration & dosage; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D016529:Emergency Nursing; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D019148:Neuromuscular Blockade; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D009657:North Carolina / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013390:Succinylcholine / Q000008:administration & dosage*; D014673:Vecuronium Bromide / Q000008:administration & dosage
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D001285:Atropine; D014673:Vecuronium Bromide; D008012:Lidocaine; D013390:Succinylcholine; D008874:Midazolam