Determinants of Success and Failure in Prehospital Endotracheal Intubation.
BACKGROUND
This study aimed to identify factors associated with successful endotracheal intubation (ETI) by a multisite emergency medical services (EMS) agency.


METHODS
We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth). We analyzed patient and EMS factors affecting ETI.


RESULTS
During 12,527 emergent ambulance responses, 200 intubation attempts were made in 150 patients. Intubation was successful in 113 (75%). A crew with paramedics was more than three times as likely to achieve successful intubation as a paramedic/emergency medical technician-Basic crew (odds ratio [OR], 3.30; p=0.03). A small tube (≤7.0 inches) was associated with a more than 4-fold increased likelihood of successful ETI compared with a large tube (≥7.5 inches) (OR, 4.25; p=0.01). After adjustment for these features, compared with little or no view of the glottis, a partial or entire view of the glottis was associated with a nearly 13-fold (OR, 12.98; p=0.001) and a nearly 40-fold (OR, 39.78; p<0.001) increased likelihood of successful intubation, respectively.


CONCLUSIONS
Successful ETI was more likely to be accomplished when a paramedic was partnered with another paramedic, when some or all of the glottis was visible and when a smaller endotracheal tube was used.
Mayo Clinic, Gold Cross, Rochester, Minnesota.
Lucas A
LA
Myers
Mayo Clinic, Gold Cross, Rochester, Minnesota.
Charles G
CG
Gallet
Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
Logan J
LJ
Kolb
Mayo Clinic, Division of Biomedical Statistics and Informatics, Rochester, Minnesota.
Christine M
CM
Lohse
Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
Christopher S
CS
Russi
D002983:Clinical Competence; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000523:psychology*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D011446:Prospective Studies