Prehospital airway management: a prospective evaluation of anaesthesia trained emergency physicians.
OBJECTIVE
To determine the characteristics of prehospital tracheal intubation and the incidence of difficult-to-manage airways in out-of-hospital patients managed by emergency medicine physicians with anaesthesia training.


METHODS
In a prospective study, conducted over a 4-year period, we evaluated all airway interventions performed by anaesthesia-trained emergency physicians.


RESULTS
One thousand, one hundred and six out of 16,559 patients (6.8%) required tracheal intubation. Orotracheal intubation was attempted in 982, laryngoscopic aided nasotracheal intubation in 64 and blind nasotracheal intubation in 90 of the cases. Two techniques were used in 30 patients. Failure rates were 2.4, 8.1 and 25.6%, respectively. A Combitube or LMA was used in 2.0%. In one case of failed Combitube insertion successful needle cricothyrotomy was performed. In patients undergoing direct laryngoscopy, Cormack-Lehane laryngeal grade views I-IV were seen in 52.0, 28.8, 12.6 and 6.6% of cases, respectively. A difficult to manage airway (DMA) was reported in 14.8%, multiple intubation attempts in 4.3% and failed intubation in 2.0% of all cases. Grouping patients based on clinical presentation revealed a significantly higher incidence of DMA in trauma patients (18.6%) and during cardiopulmonary resuscitation (16.7%) than in the remaining patient group (9.8%). Intubation failed significantly more often in trauma (3.9%) than in the remaining patient group (1.1%).


CONCLUSIONS
When compared to studies on laryngoscopy performed in the operating room, this study demonstrated a higher incidence of difficult and failed laryngoscopy, DAM, and high laryngeal grade views when patients were managed in a prehospital setting by anaesthesia trained physicians.
Timmermann
Arnd
A
Department of Anesthesiology, Emergency and Intensive Care and Medicine, Georg-August University of Goettingen, Germany. atimmer@zari.de
Eich
Christoph
C
Russo
Sebastian G
SG
Natge
Ulrich
U
Bräuer
Anselm
A
Rosenblatt
William H
WH
Braun
Ulrich
U
D000328:Adult; D000368:Aged; D000776:Anesthesiology / Q000193:education*; D004635:Emergency Medicine / Q000193:education*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies