Paramedic rapid sequence intubation in patients with non-traumatic coma.
BACKGROUND
Pre-hospital intubation by paramedics is widely used in comatose patients prior to transportation to hospital, but the optimal technique for intubation is uncertain. One approach is paramedic rapid sequence intubation (RSI), which may improve outcomes in adult patients with traumatic brain injury. However, many patients present to emergency medical services with coma of non-traumatic cause and the role of paramedic RSI in these patients remains uncertain.


METHODS
The electronic Victorian Ambulance Clinical Information System was searched for the term 'suxamethonium' between 2008 and 2011. We reviewed the patient care records and included patients with suspected non-traumatic coma who were treated and transported by road-based paramedics. Demographics, intubation conditions, vital signs (before and after drug administration) and complications were recorded. Younger patients (<60 years) were compared with older patients.


RESULTS
There were 1152 paramedic RSI attempts of which 551 were for non-traumatic coma. The success rate for intubation was 97.5%. There was a significant drop in blood pressure in younger patients (<60 years) with the mean systolic blood pressure decreasing by 16 mm Hg (95% CI 11 to 21). In older patients, the systolic blood pressure also decreased significantly by 20 mm Hg (95% CI 17 to 24). Four patients suffered brief cardiac arrest during pre-hospital care, all of whom were successfully resuscitated and transported to hospital.


CONCLUSIONS
Paramedic RSI in patients with non-traumatic coma has a high procedural success rate. Further studies are required to determine whether this procedure improves outcomes.
Ambulance Victoria, Doncaster, Victoria, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia The Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
S A
SA
Bernard
Ambulance Victoria, Doncaster, Victoria, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
K
K
Smith
The Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
R
R
Porter
Ambulance Victoria, Doncaster, Victoria, Australia.
C
C
Jones
Ambulance Victoria, Doncaster, Victoria, Australia.
A
A
Gailey
Ambulance Victoria, Doncaster, Victoria, Australia.
B
B
Cresswell
Ambulance Victoria, Doncaster, Victoria, Australia.
D
D
Cudini
Ambulance Victoria, Doncaster, Victoria, Australia.
S
S
Hill
Ambulance Victoria, Doncaster, Victoria, Australia.
B
B
Moore
Ambulance Victoria, Doncaster, Victoria, Australia.
T
T
St Clair
D000328:Adult; D000368:Aged; D000488:Allied Health Personnel; D003128:Coma / Q000209:etiology*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage; D013390:Succinylcholine / Q000008:administration & dosage; D016896:Treatment Outcome; D014739:Victoria
D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine
Airway; Neurology; Paramedics