Paramedic-performed rapid sequence intubation of patients with severe head injuries.
OBJECTIVE
We evaluate the ability of paramedic rapid sequence intubation (RSI) to facilitate intubation of patients with severe head injuries in an urban out-of-hospital system.


METHODS
Adult patients with head injuries were prospectively enrolled over a 1-year period by using the following inclusion criteria: Glasgow Coma Scale score of 3 to 8, transport time of greater than 10 minutes, and inability to intubate without RSI. Midazolam and succinylcholine were administered before laryngoscopy, and rocuronium was given after tube placement was confirmed by means of capnometry, syringe aspiration, and pulse oximetry. The Combitube was used as a salvage airway device. Outcome measures included intubation success rates, preintubation and postintubation oxygen saturation values, arrival arterial blood gas values, and total out-of-hospital times for patients intubated en route versus on scene.


RESULTS
Of 114 enrolled patients, 96 (84.2%) underwent successful endotracheal intubation, and 17 (14.9%) underwent Combitube intubation, with only 1 (0.9%) airway failure. There were no unrecognized esophageal intubations. On arrival at the trauma center, median oxygen saturation was 99%, mean arrival PO2 was 307 mm Hg, and mean arrival PCO2 was 35.8 mm Hg. Total out-of-hospital times were higher when RSI was performed on scene (26 versus 13 minutes).


CONCLUSIONS
Paramedics can use RSI protocols that include neuromuscular blocking and sedative agents to facilitate intubation of patients with head injuries.
San Diego County Emergency Medical Service, CA, USA.
Mel
M
Ochs
Daniel
D
Davis
David
D
Hoyt
David
D
Bailey
Lawrence
L
Marshall
Peter
P
Rosen
D000328:Adult; D000488:Allied Health Personnel; D006259:Craniocerebral Trauma / Q000097:blood / Q000150:complications / Q000628:therapy*; D004632:Emergency Medical Services; D006801:Humans; D006993:Hypnotics and Sedatives; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D008874:Midazolam; D019148:Neuromuscular Blockade; D009467:Neuromuscular Depolarizing Agents; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D013390:Succinylcholine
D006993:Hypnotics and Sedatives; D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine; D008874:Midazolam; D010100:Oxygen