The effectiveness of midazolam as a single pharmacologic agent to facilitate endotracheal intubation by paramedics.
OBJECTIVE
Endotracheal intubation (ETI) remains the "gold standard" for securing a patient's airway. In recent years, the use of pharmacologic agents to assist paramedics achieve successful intubation of problematic airways has become more common. This study was done to determine the efficacy of intravenous midazolam, a short-acting benzodiazepine, as a drug to facilitate intubation in patients resistant to conventional ETI.


METHODS
This retrospective observational study reviewed the 22-month experience of a suburban municipal EMS system after midazolam was introduced as an agent to be used for systemic sedation to facilitate ETI. All calls where midazolam was used were reviewed on a monthly basis by investigators via retrospective review of the prehospital care reports.


RESULTS
During the study period 13,212 emergency responses occurred, resulting in 154 ETIs by paramedics. Midazolam was used to facilitate 20 (13%) of these ETIs. "Clenched teeth" and failed conventional intubation were the most commonly cited indications for facilitated intubation. Eleven patients had medical complaints and nine were trauma patients. Successful ETI with midazolam was achieved in 17 of 20 (85%) cases. In 85% (15 of 17) of these cases, a single dose of midazolam was sufficient for ETI [mean dose 3.6 mg (SD 1.1 mg)]. The three patients with failed ETI received multiple doses of midazolam [mean dose 5.0 mg (SD 2.0 mg)].


CONCLUSIONS
The prehospital use of single-dose IV midazolam is generally effective in accomplishing facilitated ETI in patients resistant to conventional (nonpharmacologic) ETI.
Dickinson
E T
ET
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104-4283, USA. eddickin@mail.med.upenn.edu
Cohen
J E
JE
Mechem
C C
CC
D000488:Allied Health Personnel; D016292:Procedural Sedation / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007275:Injections, Intravenous; D007442:Intubation, Intratracheal; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
D006993:Hypnotics and Sedatives; D008874:Midazolam