title: Field intubation of cardiac arrest patients: a dying art?
abstract: BACKGROUND
  The most appropriate advanced airway intervention in out-of-hospital cardiac arrest (OHCA) is unproven. This study reviews prehospital advanced airway management and its complications in OHCA patients.
  
  
  METHODS
  A 4-year, observational, retrospective case review. Patients attending the Emergency Department of the Royal Infirmary of Edinburgh, Scotland, with a primary diagnosis of OHCA were identified. Patient demographics, survival to admission, airway management technique and complication rates were identified.
  
  
  RESULTS
  Seven hundred and ninety-four cases were identified. The aetiology of cardiac arrest was medical in 95.2%, traumatic in 3.9% and unrecorded in 0.9%. Prehospital intubation was attempted in 628 patients. Prehospital intubation was successful in 573 patients. A significant complication (multiple attempts, displaced endotracheal tube or oesophageal intubation) occurred in 55 (8.8%) patients. 165 (20.8%) patients survived to hospital admission, of whom 110 had undergone prehospital intubation. 55 patients who did not undergo prehospital tracheal intubation survived to hospital admission.
  
  
  CONCLUSIONS
  The optimal method of maintaining an airway and ventilating an OHCA patient has yet to be established. Prehospital tracheal intubation for OHCA is associated with significant complications and may reduce survival. The use of tracheal intubation as a routine intervention should be reconsidered. Ambulance services should consider adopting alternative strategies in airway management.
authors.affiliation: Department of Emergency Medicine, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK. richardlyon@doctors.org.uk
authors.forename: Richard M
authors.initials: RM
authors.lastname: Lyon
authors.forename: John D
authors.initials: JD
authors.lastname: Ferris
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Young
authors.forename: Dermot W
authors.initials: DW
authors.lastname: McKeown
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Oglesby
authors.forename: Colin
authors.initials: C
authors.lastname: Robertson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D012606:Scotland; D016019:Survival Analysis