Patient status and time to intubation in the assessment of prehospital intubation performance.
Assessment of paramedic endotracheal intubation (ETI) performance often does not account for varied clinical conditions or the time required to complete the procedure.


OBJECTIVE
To demonstrate the utility of patient status and time to intubation (TTI) for evaluating prehospital ETI performance.


METHODS
Paramedic charts were reviewed for the period January-December 1998. Patient clinical status was defined as cardiac arrest (absence of perfusing rhythm) or non-cardiac arrest (presence of perfusing rhythm). Method, route, and success of ETI were noted. The TTI was determined as the elapsed time from on-scene arrival to securing of the endotracheal tube. Time elapsed from on-scene arrival to emergency department arrival was noted for instances of failed ETI. Statistical analysis was performed using chi-square and survival analysis (Kaplan-Meier estimator).


RESULTS
Computer records were available for 26,026 patient contacts. Of 893 documented ETI attempts, 771 (86%) were successful. The ETI success rate was significantly higher (p<0.001) for cardiac arrests (551 of 591, 93.2%) than for non-cardiac arrests (220 of 302, 72.9%). Median TTIs were 5 minutes (95% CI: 5, 5) for cardiac arrests and 17 minutes (95% CI: 14, 20) for non-cardiac arrests; this difference was significant (p<0.001). For non-cardiac arrests, ETI success was significantly (p = 0.002) higher for orotracheal intubation (OTI) (168 of 214, 78.5%) than for nasotracheal intubation (NTI) (52 of 88, 59.1%). Median TTIs were 15 minutes (95% CI: 13, 17) for OTI and 25 minutes (95% CI: 23, 27) for NTI; this difference was significant (p = 0.002). For non-cardiac arrests, the difference i
Wang
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Department of Emergency Medicine, Christiana Care Health System Newark, Delaware, USA. wanghe@msx.upmc.edu
O'Connor
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Schnyder
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Barnes
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Megargel
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D003691:Delaware / Q000453:epidemiology; D004632:Emergency Medical Services / Q000592:standards*; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007442:Intubation, Intratracheal / Q000379:methods / Q000592:standards*; D008874:Midazolam / Q000008:administration & dosage; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D016019:Survival Analysis; D013996:Time and Motion Studies
D006993:Hypnotics and Sedatives; D008874:Midazolam