Trauma intubations: can a protocol-driven approach be successful?
OBJECTIVE
To determine the success rate of a trauma airway protocol.


METHODS
This was a prospective cohort study of trauma patients requiring intubation conducted for 24 months. The study facility is a Level I trauma center serving an urban population. The protocol suggests that the first two attempts at intubation be by the third-year emergency medicine resident, a hospital-wide stat overhead page for anesthesia occurs, which results in anesthesia (occasionally a resident only, but usually an attending) presence in the trauma room in 5 to 10 minutes. After each intubation, the emergency medicine resident or the attending physician completed a data collection form indicating the number of intubation attempts and result of each one, who performed each attempt, complications related to each attempt, and airway adjuncts used.


RESULTS
Two hundred seventy-four patients were intubated during the study period by either emergency medicine physician or anesthesiologist with a success rate of 91.6% after the third attempt. The complication and cricothyrotomy rates were 9.8% and 2.6%, respectively.


CONCLUSIONS
Our trauma airway protocol allows for the safe and effective management of the trauma airway.
Casey
Zoe C
ZC
Emergency Department, Connecticut Children's Medical Center, Hartford Hospital, Hartford, Connecticut, USA. zcasey@ccmckids.org
Smally
Alan J
AJ
Grant
Robert J
RJ
McQuay
Jacqueline
J
D000328:Adult; D002648:Child; D002985:Clinical Protocols; D015331:Cohort Studies; D003237:Connecticut; D004635:Emergency Medicine / Q000193:education / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007396:Internship and Residency / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000145:classification / Q000628:therapy*