The utilization of midazolam as a pharmacologic adjunct to endotracheal intubation by paramedics.
OBJECTIVE
Pharmacologic agents have been used in the prehospital setting for facilitating endotracheal intubation (ETI). The purpose of this study was to determine the utility of intravenous midazolam for prehospital patients who require pharmacologic relaxation to facilitate ETI.


METHODS
Data were reviewed retrospectively using paramedic charts from an eight-month period for a three-county state EMS system.


RESULTS
There were 26,133 paramedic dispatches during the study period. Six hundred eighty-three ETIs were attempted, including 72 midazolam-facilitated intubations (MFIs). The most common indications for MFI were "clenched teeth," "gag," and "combativeness." Successful MFI was achieved in 45 of 72 cases (62.5%). Midazolam-facilitated intubation was less successful for trauma patients (41.2%) than for medical patients (69.1 %) (p = 0.04). Of the 58 failed conventional ETIs that occurred during the study period, 25 (43.1%) were identified as having one or more indications for the use of MFI. Although the use of intravenous midazolam was effective in facilitating ETI, a high MFI failure rate (37.5%) was noted.


CONCLUSIONS
Although it is of limited efficacy, MFI is underutilized and should be considered by medical direction as a pharmacologic adjunct to ETI in selected field patients.
Wang
H E
HE
Department of Emergency Medicine, Christiana Care Health System-The Medical Center of Delaware, Newark 19218, USA. hwang813@aol.com
O'Connor
R E
RE
Megargel
R E
RE
Bitner
M
M
Stuart
R
R
Bratton-Heck
B
B
Lamborn
M
M
Tan
L
L
D003691:Delaware; D004638:Emergency Treatment / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007275:Injections, Intravenous; D007442:Intubation, Intratracheal / Q000379:methods*; D008874:Midazolam / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D008874:Midazolam