The effect of Combitube use on paramedic experience in endotracheal intubation.
OBJECTIVE
To determine the change in number of endotracheal intubations per paramedic after the implementation of Combitube use and to explore consequences.


METHODS
Before-and-after study; urban/suburban EMS system; population 1 million. Number of patients 16 years and older, type of airway used, attempts, and successes were abstracted for time periods before and after the use of Combitubes. The number of endotracheal intubations/paramedic for each period was calculated.


RESULTS
Three-year pre-Combitube: patients 50983; 6.6% arrests; 3142 received an endotracheal intubation attempt with 93.5% success. The average annual number of paramedics was 153 with 6.9 +/- 6.4 intubations per paramedic per year. Three-year post-Combitube: patients 55959; 6.0% arrests; 2913 received an advanced airway attempt: 860 Combitubes, success 89.4%; 2144 endotracheal intubations, success 91.6% (95% confidence interval success rate difference, 0.5-3.3; P = .007). The average annual number of paramedics was 177 with 3.7 +/- 3.3 intubations per paramedic per year.


CONCLUSIONS
After implementation of the Combitube, the number of endotracheal intubation attempts/paramedic and success rates decreased.
Cady
Charles E
CE
Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA. cecady@mcw.edu
Pirrallo
Ronald G
RG
D000293:Adolescent; D000328:Adult; D002983:Clinical Competence; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017211:Treatment Failure