title: Difficult Intubation Factors in Prehospital Rapid Sequence Intubation by an Australian Helicopter Emergency Medical Service.
abstract: OBJECTIVE
  Prehospital rapid sequence intubation (RSI) of critically ill trauma patients is a high-risk procedure that may be associated with an increased rate of severe complications such as failed intubation, failure of oxygenation, hypoxia, hypotension, or need for surgical airway. The objective of this study was to describe the factors associated with difficult intubation in prehospital RSI as defined by more than a single look at laryngoscopy to achieve tracheal intubation.
  
  
  METHODS
  This is an observational study using prospectively collected data.
  
  
  RESULTS
  Four hundred forty-three RSIs were performed. Paramedics were the initial laryngoscopist in 290 (65.5%). First-look laryngoscopy resulted in successful tracheal intubation (TI) in 372 (84.0%) (95% confidence interval, 80.3%-87.1%). Intubation was achieved on second look at laryngoscopy in 58 (13.1%). "First-pass" TI was achieved in 394 (88.9%). Overall, successful TI was achieved in 438 (98.9%) (95% confidence interval, 97.4%-99.5%). Complications occurred in 116 (26.2%), with desaturation the commonest in 77 (17.4%).
  
  
  CONCLUSIONS
  Factors associated with more than 1 look at laryngoscopy before TI included paramedic laryngoscopist and the presence of at least 1 of the following indicators: blood/vomitus in the airway, limited mouth opening, and limited neck movement. Trauma to face/neck, obese body habitus, C-spine precautions, cricoid pressure, midline stabilization, and intubation on the ground did not influence the level of difficulty encountered.
authors: Greater Sydney Area Helicopter Emergency Medical Service, NSW Ambulance; Discipline of Emergency Medicine, Sydney University. Electronic address: bburns_2000@yahoo.com.
authors: Brian
authors: B
authors: Burns
authors: Greater Sydney Area Helicopter Emergency Medical Service, NSW Ambulance; Discipline of Emergency Medicine, Sydney University.
authors: Karel
authors: K
authors: Habig
authors: Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, UK.
authors: Hilary
authors: H
authors: Eason
authors: Greater Sydney Area Helicopter Emergency Medical Service, NSW Ambulance; Discipline of Emergency Medicine, Sydney University.
authors: Sandra
authors: S
authors: Ware
mesh_terms: D000328:Adult; D017732:Air Ambulances; D000488:Allied Health Personnel; D001315:Australia / Q000453:epidemiology; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007022:Hypotension / Q000453:epidemiology*; D000860:Hypoxia / Q000453:epidemiology*; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D007828:Laryngoscopy; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D014140:Tracheotomy / Q000706:statistics & numerical data*; D017211:Treatment Failure