title: Tracheal intubation related complications in the prehospital setting.
abstract: BACKGROUND
  Prehospital tracheal intubation (TI) is associated with morbidity and mortality, particularly in cases of difficult intubation. The goal of the present study was to describe factors associated with TI related complications in the prehospital setting.
  
  
  METHODS
  This was a prospective cohort study including all patients intubated on scene in a prehospital emergency medical service over a 4 year period. TI related complications included oxygen desaturation, aspiration, vomiting, bronchospasm and/or laryngospasm, and mechanical complications (mainstem intubation, oesophageal intubation and airway lesion- that is, dental or laryngeal trauma caused by the laryngoscope). Difficult intubation was defined as >2 failed laryngoscopic attempts, or the need for any alternative TI method. A multivariate logistic regression was used to identify the risk factors for TI related complications.
  
  
  RESULTS
  1251 patients were included; 208 complications occurred in 165 patients (13.1%). Among the 208 complications, the most frequent were oesophageal intubation (n=69, 29.7%), desaturation (n=58, 25.0%) and mainstem intubation (n=37, 15.9%). In multivariate analysis, difficult intubation (OR=6.13, 3.93 to 9.54), Cormack and Lehane grades 3 and 4 (OR=2.23, 1.26 to 3.96 for Cormack and Lehane grade 3 and OR=2.61, 1.28 to 5.33 for Cormack and Lehane grade 4 compared with Cormack and Lehane grade 1) and a body mass index >30 kg/m(2) (OR=2.22, 1.38 to 3.56) were significantly associated with TI related complications.
  
  
  CONCLUSIONS
  Despite specific guidelines, TI related complications are more frequent in the prehospital setting when intubation is deemed difficult, the Cormack and Lehane grade is greater than grade 1 and the patient is overweight. In such situations, particular attention is needed to avoid complications.
authors.affiliation: Service Mobile d'Urgences et Réanimation, AP-HP Hôpital Beaujon, Université Paris 7, Clichy, France Equipe ECSTRA, Centre de Recherche Epidémiologies et Biostatistique Sorbonne Paris Cité, UMR 1153, Inserm, Université Paris Diderot, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Caruana
authors.affiliation: Service Mobile d'Urgences et Réanimation, AP-HP Hôpital Beaujon, Université Paris 7, Clichy, France.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Duchateau
authors.affiliation: Service Mobile d'Urgences et Réanimation, AP-HP Hôpital Beaujon, Université Paris 7, Clichy, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Cornaglia
authors.affiliation: Service Mobile d'Urgences et Réanimation, AP-HP Hôpital Beaujon, Université Paris 7, Clichy, France.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Devaud
authors.affiliation: Equipe ECSTRA, Centre de Recherche Epidémiologies et Biostatistique Sorbonne Paris Cité, UMR 1153, Inserm, Université Paris Diderot, Paris, France Département Anesthésie Réanimation, Hôpital Européen Georges Pompidou, APHP, Université Paris 7 Diderot, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Pirracchio
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007828:Laryngoscopy / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
keywords: emergency departments; primary care