title: Prehospital airway management: A prospective case study.
abstract: We conducted a one-year prospective study involving a prehospital Emergency Medical Service in the Netherlands to investigate the incidence of failed or difficult prehospital endotracheal intubation. During the study period the paramedics were asked to fill in a registration questionnaire after every endotracheal intubation. Of the 26,271 patient contacts, 256 endotracheal intubations were performed by paramedics in one year. Endotracheal intubation failed in 12 patients (4.8%). In 12.0% of 249 patients, a Cormack and Lehane grade III laryngoscopy was reported and a grade IV laryngoscopy was reported in 10.4%. The average number of endotracheal intubations per paramedic in one year was 4.2 and varied from zero to a maximum of 12. The median time between arrival on the scene and a positive capnograph was 7 min.38 s in the case of a Cormack and Lehane grade I laryngoscopy and 14 min.58 s in the case of a Cormack and Lehane grade 4 laryngoscopy. The incidence of endotracheal intubations performed by Dutch paramedics in one year was low, but endotracheal intubation was successful in 95.2%, which is comparable with findings in international literature. Early capnography should be used consistently in prehospital airway management.
authors: Department of Anesthesiology, Maastricht University Medical Center, Maastricht, the Netherlands. n_wilbers@hotmail.com
authors: N E R
authors: NE
authors: Wilbers
authors: A E W
authors: AE
authors: Hamaekers
authors: J
authors: J
authors: Jansen
authors: S C
authors: SC
authors: Wijering
authors: O
authors: O
authors: Thomas
authors: R
authors: R
authors: Wilbers-van Rens
authors: A A J
authors: AA
authors: van Zundert