title: Advances in prehospital airway management.
abstract: Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome. In studies demonstrating poor outcomes related to prehospital-attempted endotracheal intubation (ETI), both training and skill level of the provider are usually often low. Research supports a relationship between the number of intubation experiences and ETI success. National standards for certification of emergency medicine provider are in general too low to guarantee good success rate in emergency airway management by paramedics and physicians. Some paramedic training programs require more intense airway training above the national standard and some EMS systems in Europe staff their system with anesthesia providers instead. ETI remains the cornerstone of definitive prehospital airway management, However, ETI is not without risk and outcomes data remains controversial. Many systems may benefit from more input and guidance by the anesthesia department, which have higher volumes of airway management procedures and extensive training and experience not just with training of airway management but also with different airway management techniques and adjuncts.
authors.affiliation: University of Washington/Harborview Medical Center, Box 359724, 325 Ninth Avenue, Seattle, WA 98104.
authors.forename: Pe
authors.initials: P
authors.lastname: Jacobs
authors.affiliation: University of Washington/Harborview Medical Center, Box 359724, 325 Ninth Avenue, Seattle, WA 98104.
authors.forename: A
authors.initials: A
authors.lastname: Grabinsky
keywords: Airway; anesthesiology; emergency; management; prehospital
references.citation: J Emerg Med. 2003 Oct;25(3):251-6
references.pmid: 14585451
references.citation: Circulation. 2007 Dec 18;116(25):2908-12
references.pmid: 18071077
references.citation: Anesth Analg. 2009 Aug;109(2):489-93
references.pmid: 19608824
references.citation: Anasthesiol Intensivmed Notfallmed Schmerzther. 2003 Oct;38(10):630-42
references.pmid: 14508702
references.citation: JAMA. 2008 Sep 24;300(12):1423-31
references.pmid: 18812533
references.citation: Emerg Med Clin North Am. 2008 Nov;26(4):881-97, vii
references.pmid: 19059088
references.citation: Crit Care. 2011;15(5):R236
references.pmid: 21985431
references.citation: J Emerg Med. 2009 Apr;36(3):257-65
references.pmid: 18439793
references.citation: Circulation. 2008 Apr 22;117(16):2162-7
references.pmid: 18378619
references.citation: Resuscitation. 2012 Aug;83(8):1025-30
references.pmid: 22465807
references.citation: J Trauma. 2005 Nov;59(5):1140-5; discussion 1145-7
references.pmid: 16385292
references.citation: Prehosp Emerg Care. 2006 Jul-Sep;10(3):356-62
references.pmid: 16801280
references.citation: Resuscitation. 2003 Jul;58(1):49-58
references.pmid: 12867309
references.citation: Curr Opin Anaesthesiol. 2008 Apr;21(2):222-7
references.pmid: 18443493
references.citation: Lancet. 2010 Apr 17;375(9723):1347-54
references.pmid: 20202679
references.citation: J Trauma Acute Care Surg. 2012 Aug;73(2 Suppl 1):S38-42
references.pmid: 22847092
references.citation: Prehosp Emerg Care. 2012 Apr-Jun;16(2):284-8
references.pmid: 22229954
references.citation: Circulation. 2013 Jan 29;127(4):435-41
references.pmid: 23230313
references.citation: Acad Emerg Med. 2006 Jun;13(6):596-601
references.pmid: 16614455
references.citation: J Surg Res. 2011 Oct;170(2):286-90
references.pmid: 21550060
references.citation: Resuscitation. 2011 Nov;82(11):1405-9
references.pmid: 21763393
references.citation: Ann Emerg Med. 2007 Mar;49(3):293-301
references.pmid: 16978737
references.citation: JAMA. 2013 Jan 16;309(3):257-66
references.pmid: 23321764
references.citation: J Spec Oper Med. 2011 Spring-Summer;11(2):16-19
references.pmid: 21706457
references.citation: Prehosp Emerg Care. 2011 Apr-Jun;15(2):184-92
references.pmid: 21309705
references.citation: Can J Anaesth. 2012 Jan;59(1):41-52
references.pmid: 22042705
references.citation: Acta Anaesthesiol Scand. 2012 Feb;56(2):164-71
references.pmid: 22060976
references.citation: Scand J Trauma Resusc Emerg Med. 2012 Dec 18;20:84
references.pmid: 23249522
references.citation: Prehosp Emerg Care. 2006 Oct-Dec;10(4):430-9
references.pmid: 16997770
references.citation: BMC Anesthesiol. 2012 Jun 21;12:11
references.pmid: 22720884
references.citation: J Emerg Med. 2002 Aug;23(2):183-9
references.pmid: 12359289
references.citation: Resuscitation. 2011 Apr;82(4):378-85
references.pmid: 21288624
references.citation: Br J Anaesth. 2012 Sep;109(3):454-8
references.pmid: 22661751
references.citation: Prehosp Emerg Care. 2005 Apr-Jun;9(2):156-62
references.pmid: 16036839
references.citation: Anesthesiology. 2011 Jan;114(1):34-41
references.pmid: 21150569
references.citation: J Trauma. 2008 Jun;64(6):1548-54
references.pmid: 18545122
references.citation: Can J Anaesth. 2007 Feb;54(2):124-8
references.pmid: 17272251
references.citation: Circulation. 2010 Nov 2;122(18 Suppl 3):S685-705
references.pmid: 20956221
references.citation: Resuscitation. 2011 Dec;82(12):1529-36
references.pmid: 21763247
references.citation: Circulation. 1997 Dec 16;96(12):4364-71
references.pmid: 9416905
references.citation: Resuscitation. 2012 Sep;83(9):1061-6
references.pmid: 22664746
references.citation: Pediatrics. 2008 Aug;122(2):e294-7
references.pmid: 18644845
references.citation: Scand J Trauma Resusc Emerg Med. 2011 Jan 17;19(1):4
references.pmid: 21241469
references.citation: Ann Emerg Med. 2001 Jan;37(1):32-7
references.pmid: 11145768
references.citation: Anesth Analg. 1998 Sep;87(3):734-6
references.pmid: 9728866
references.citation: Anesthesiology. 2003 May;98(5):1269-77
references.pmid: 12717151
references.citation: Anesth Analg. 1992 Apr;74(4):531-4
references.pmid: 1554118
references.citation: Anesth Analg. 2009 Nov;109(5):1560-5
references.pmid: 19713258