Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service.
BACKGROUND
Anaesthesiologists are airway management experts, which is one of the reasons why they serve as pre-hospital emergency physicians in many countries. However, limited data are available on the actual quality and safety of anaesthesiologist-managed pre-hospital endotracheal intubation (ETI). To explore whether the general indications for ETI are followed and what complications are recorded, we analysed the use of pre-hospital ETI in severely traumatised patients treated by anaesthesiologists in a Norwegian helicopter emergency medical service (HEMS).


METHODS
A retrospective audit of prospectively registered data concerning patients with trauma as the primary diagnosis and a National Committee on Aeronautics score of 4 - 7 during the period of 1994-2005 from a mixed rural/urban Norwegian HEMS was performed.


RESULTS
Among the 1255 cases identified, 238 successful pre-hospital ETIs out of 240 attempts were recorded (99.2% success rate). Furthermore, we identified 47 patients for whom ETI was performed immediately upon arrival to the emergency department (ED). This group represented 16% of all intubated patients. Of the ETIs performed in the ED, 43 patients had an initial Glasgow Coma Score (GCS) < 9. Compared to patients who underwent ETI in the ED, patients who underwent pre-hospital ETI had significantly lower median GCS (3 (3-6) vs. 6 (4-8)), lower revised trauma scores (RTS) (3.8 (1.8-5.9) vs. 5.0 (4.1-6.0)), longer mean scene times (23 +/- 13 vs. 11 +/- 11 min) and longer mean transport times (22 +/- 16 vs. 13 +/- 14 min). The audit also revealed that very few airway management complications had been recorded.


CONCLUSIONS
We found a very high success rate of pre-hospital ETI and few recorded complications in the studied anaesthesiologist-manned HEMS. However, a substantial number of trauma patients were intubated first on arrival in the ED. This delay may represent a quality problem. Therefore, we believe that more studies are needed to clarify the reasons for and possible clinical consequences of the delayed ETIs.
Sollid
Stephen J M
SJ
Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway. solste@snla.no
Lossius
Hans Morten
HM
Søreide
Eldar
E
D017732:Air Ambulances; D000776:Anesthesiology; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000592:standards*; D008297:Male; D008485:Medical Audit; D009664:Norway; D017063:Outcome Assessment, Health Care; D010820:Physicians; D011787:Quality of Health Care; D012189:Retrospective Studies; D015599:Trauma Severity Indices