title: Incidence of difficult airway situations during prehospital airway management by emergency physicians--a retrospective analysis of 692 consecutive patients.
abstract: BACKGROUND
  In the prehospital setting, advanced airway management is challenging as it is frequently affected by facial trauma, pharyngeal obstruction or limited access to the patient and/or the patient's airway. Therefore, incidence of prehospital difficult airway management is likely to be higher compared to the in-hospital setting and success rates of advanced airway management range between 80 and 99%.
  
  
  METHODS
  3961 patients treated by an emergency physician in Zurich, Switzerland were included in this retrospective analysis in order to determine the incidence of a difficult airway along with potential circumstantial risk factors like gender, necessity of CPR, NACA score, GCS, use and type of muscle relaxant and use of hypnotic drugs.
  
  
  RESULTS
  692 patients underwent advanced prehospital airway management. Seven patients were excluded due to incomplete or incongruent documentation, resulting in 685 patients included in the statistical analysis. Difficult intubation was recorded in 22 patients, representing an incidence of a difficult airway of 3.2%. Of these 22 patients, 15 patients were intubated successfully, whereas seven patients (1%) had to be ventilated with a bag valve mask during the whole procedure.
  
  
  CONCLUSIONS
  In this physician-led service one out of five prehospital patients requires airway management. Incidence of advanced prehospital difficult airway management is 3.2% and eventual success rate is 99%, if performed by trained emergency physicians. A total of 1% of all prehospital intubation attempts failed and alternative airway device was necessary.
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Nils
authors.initials: N
authors.lastname: Thoeni
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Piegeler
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Brueesch
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Sulser
authors.affiliation: Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Haas
authors.affiliation: Schutz und Rettung, Ambulance Service, Zurich, Switzerland.
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Mueller
authors.affiliation: Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland. Electronic address: kurt.ruetzler@usz.ch.
authors.forename: Kurt
authors.initials: K
authors.lastname: Ruetzler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management; D016887:Cardiopulmonary Resuscitation; D004363:Drug Utilization; D004632:Emergency Medical Services; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D015994:Incidence; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D010820:Physicians; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D009125:Muscle Relaxants, Central
keywords: Emergency physician; Prehospital airway management; Tracheal intubation