title: Out-of-hospital airway management in the United States.
abstract: OBJECTIVE
  Prior studies describe airway management by single EMS agencies, regions or states. We sought to characterize out-of-hospital airway management interventions, outcomes and complications across the United States.
  
  
  METHODS
  Using the 2008 National Emergency Medical Services Information System (NEMSIS) Public-Release Data Set containing data from 16 states, we identified patients receiving advanced airway management, including endotracheal intubation (ETI), alternate airways (Combitube, Laryngeal Mask Airway (LMA), King LT, Esophageal-Obturator Airway (EOA)), and cricothyroidotomy (needle and open). We examined airway management success and complications in the full cohort and in key subsets (cardiac arrest, non-arrest medical, non-arrest injury, children <10 and 10-19 years, rapid-sequence intubation (RSI), population setting and US census region). We analyzed the data using descriptive statistics.
  
  
  RESULTS
  Among 4,383,768 EMS activations, there were 10,356 ETI, 2246 alternate airways, and 88 cricothyroidotomies. ETI success rates were: overall 6482/8418 (77.0%; 95% CI: 76.1-77.9%), cardiac arrest 3494/4482 (78.0%), non-arrest medical 616/846 (72.8%), non-arrest injury 417/505 (82.6%), children <10 years 295/397 (74.3%), children 10-19 years 228/289 (78.9%), adult 5829/7552 (77.2%), and rapid-sequence intubation 289/355 (81.4%). ETI success was success was lowest in the South US census region. Alternate airway success was 1564/1794 (87.2%). Major complications included: bleeding 84 (7.0 per 1000 interventions), vomiting 80 (6.7 per 1000) and esophageal intubation 12 (1.0 per 1000).
  
  
  CONCLUSIONS
  In this study characterizing out-of-hospital airway management across the United States, we observed low out-of-hospital ETI success rates. These data may guide national efforts to improve the quality of out-of-hospital airway management.
authors.affiliation: Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, United States. hwang@uabmc.edu
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
authors.forename: N Clay
authors.initials: NC
authors.lastname: Mann
authors.forename: Gregory
authors.initials: G
authors.lastname: Mears
authors.forename: Karen
authors.initials: K
authors.lastname: Jacobson
authors.forename: Donald M
authors.initials: DM
authors.lastname: Yealy
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000379:methods / Q000706:statistics & numerical data*; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult