An analysis of invasive airway management in a suburban emergency medical services system.
BACKGROUND
Airway management is the most critical and potentially life-saving intervention performed by emergency medical service (EMS) providers.  Invasive airway management often is required in non-cardiac-arrest patients who are combative or otherwise uncooperative.  The success of prehospital invasive airway management in this patient population was evaluated.


METHODS
A retrospective review was undertaken of the records of all such patients requiring endotracheal intubation over a three-year period (1987-1989).  The study population included 278 patients enrolled by five advanced life support (ALS) units serving a suburban population of 425,000.  Field trip sheets were reviewed for diagnosis, intubation method and success, number of intubation attempts, provider experience, reasons for unsuccessful intubations, and complications.


RESULTS
A total of 394 invasive airway management attempts were performed on 278 patients.  The overall successful intubation rate was 75% (41% orotracheal, 52% nasotracheal, 7% other or unknown).  The most common diagnoses were COPD and pulmonary edema (30%) and trauma (24%). Experienced providers were successful on the first attempt in 57% of cases compared to 50% by inexperienced providers (p=.24).  Multiple intubation attempts were required in 33% of the patients.  There was no statistically significant difference in success rates between the orotracheal and nasotracheal methods (p=.51).  The most common reason for unsuccessful intubation was altered level of consciousness. Complications occurred with 7% of successful attempts and in 18% of unsuccessful attempts (p less than .001).  Forty-six percent of the patients who were not intubated successfully in the field and required intubation in the emergency department (ED) received a neuromuscular blocking agent prior to successful intubation.


CONCLUSIONS
Prehospital providers can intubate a high but improvable proportion of non-cardiac-arrested patients by both the orotracheal and nasotracheal routes.  The use of pharmacologic adjuncts to facilitate the prehospital intubation of selected, non-cardiac-arrested patients is a promising adjunct that needs further evaluation.
Department of Emergency Medicine, York Hospital, Pa.
T J
TJ
Krisanda
D R
DR
Eitel
D
D
Hess
R
R
Ormanoski
R
R
Bernini
N
N
Sabulsky
D016009:Chi-Square Distribution; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005069:Evaluation Studies as Topic; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D008020:Life Support Care / Q000706:statistics & numerical data*; D008499:Medical Records; D012189:Retrospective Studies