title: Airway management by physician-staffed Helicopter Emergency Medical Services - a prospective, multicentre, observational study of 2,327 patients.
abstract: BACKGROUND
  Despite numerous studies on prehospital airway management, results are difficult to compare due to inconsistent or heterogeneous data. The objective of this study was to assess advanced airway management from international physician-staffed helicopter emergency medical services.
  
  
  METHODS
  We collected airway data from 21 helicopter emergency medical services in Australia, England, Finland, Hungary, Norway and Switzerland over a 12-month period. A uniform Utstein-style airway template was used for collecting data.
  
  
  RESULTS
  The participating services attended 14,703 patients on primary missions during the study period, and 2,327 (16 %) required advanced prehospital airway interventions. Of these, tracheal intubation was attempted in 92 % of the cases. The rest were managed with supraglottic airway devices (5 %), bag-valve-mask ventilation (2 %) or continuous positive airway pressure (0.2 %). Intubation failure rates were 14.5 % (first-attempt) and 1.2 % (overall). Cardiac arrest patients showed significantly higher first-attempt intubation failure rates (odds ratio: 2.0; 95 % CI: 1.5-2.6; p < 0.001) compared to non-cardiac arrest patients. Complications were recorded in 13 %, with recognised oesophageal intubation being the most frequent (25 % of all patients with complications). For non-cardiac arrest patients, important risk predictors for first-attempt failure were patient age (a non-linear association) and administration of sedatives (reduced failure risk). The patient's sex, provider's intubation experience, trauma type (patient category), indication for airway intervention and use of neuromuscular blocking agents were not risk factors for first-attempt intubation failure.
  
  
  CONCLUSIONS
  Advanced airway management in physician-staffed prehospital services was performed frequently, with high intubation success rates and low complication rates overall. However, cardiac arrest patients showed significantly higher first-attempt failure rates compared to non-cardiac arrest patients. All failed intubations were handled successfully with a rescue device or surgical airway.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  www.clinicaltrials.gov NCT01502111 . Registered 22 December 2011.
authors.affiliation: Norwegian Air Ambulance Foundation, Drøbak, Norway. geir.arne.sunde@norskluftambulanse.no.|Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. geir.arne.sunde@norskluftambulanse.no.|Department of Health Sciences, University of Stavanger, Stavanger, Norway. geir.arne.sunde@norskluftambulanse.no.
authors.forename: Geir Arne
authors.initials: GA
authors.lastname: Sunde
authors.affiliation: Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. jkhe@helse-bergen.no.|Department of Medical Sciences, University of Bergen, Bergen, Norway. jkhe@helse-bergen.no.
authors.forename: Jon-Kenneth
authors.initials: JK
authors.lastname: Heltne
authors.affiliation: Department of Health Sciences, University of Stavanger, Stavanger, Norway. david.lockey@nbt.nhs.uk.|Institute of Prehospital Care, London's Air Ambulance, Bartshealth NHS Trust, London, UK. david.lockey@nbt.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Lockey
authors.affiliation: Sydney HEMS, Ambulance Service of NSW, Sydney, Australia. bburns_2000@yahoo.com.|Sydney Medical School, University of Sydney, Sydney, Australia. bburns_2000@yahoo.com.
authors.forename: Brian
authors.initials: B
authors.lastname: Burns
authors.affiliation: Air Ambulance Department, Oslo University Hospital, Oslo, Norway. marten.sandberg@medisin.uio.no.|Faculty of Medicine, University of Oslo, Oslo, Norway. marten.sandberg@medisin.uio.no.
authors.forename: Mårten
authors.initials: M
authors.lastname: Sandberg
authors.affiliation: UiT - The Arctic University of Norway, Tromsø, Norway. Knut.Fredriksen@unn.no.|The University Hospital of North Norway, Tromsø, Norway. Knut.Fredriksen@unn.no.
authors.forename: Knut
authors.initials: K
authors.lastname: Fredriksen
authors.affiliation: Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway. karl.ove.hufthammer@helse-bergen.no.
authors.forename: Karl Ove
authors.initials: KO
authors.lastname: Hufthammer
authors.affiliation: Hungarian Air Ambulance Nonprofit Ltd., Budaors, Hungary. akossoti@gmail.com.
authors.forename: Akos
authors.initials: A
authors.lastname: Soti
authors.affiliation: Emergency Medicine Research Group, Edinburgh, UK. richardl@kssairambulance.org.uk.|Kent, Surrey & Sussex Air Ambulance Trust, Marden, UK. richardl@kssairambulance.org.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Lyon
authors.affiliation: Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland. Helena.Jantti@kuh.fi.
authors.forename: Helena
authors.initials: H
authors.lastname: Jäntti
authors.affiliation: Emergency Medical Services, Tampere University Hospital, Tampere, Finland. Antti.Kamarainen@pshp.fi.
authors.forename: Antti
authors.initials: A
authors.lastname: Kämäräinen
authors.affiliation: Department of Emergency Medicine and Prehospital Services, St. Olavs Hospital, Trondheim, Norway. bjorn.ole.reid@stolav.no.
authors.forename: Bjørn Ole
authors.initials: BO
authors.lastname: Reid
authors.affiliation: Emergency Medical Services, Helsinki University Hospital, Helsinki, Finland. Tom.Silfvast@hus.fi.|University of Helsinki, Helsinki, Finland. Tom.Silfvast@hus.fi.
authors.forename: Tom
authors.initials: T
authors.lastname: Silfvast
authors.affiliation: Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland. Falko.Harm@usb.ch.
authors.forename: Falko
authors.initials: F
authors.lastname: Harm
authors.affiliation: Norwegian Air Ambulance Foundation, Drøbak, Norway. stephen.sollid@norskluftambulanse.no.|Department of Health Sciences, University of Stavanger, Stavanger, Norway. stephen.sollid@norskluftambulanse.no.|Air Ambulance Department, Oslo University Hospital, Oslo, Norway. stephen.sollid@norskluftambulanse.no.
authors.forename: Stephen J M
authors.initials: SJ
authors.lastname: Sollid
mesh_terms: D000401:Aircraft; D058109:Airway Management / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000628:therapy*