title: Paramedic Intubation Experience Is Associated With Successful Tube Placement but Not Cardiac Arrest Survival.
abstract: OBJECTIVE
  Paramedic experience with intubation may be an important factor in skill performance and patient outcomes. Our objective is to examine the association between previous intubation experience and successful intubation. In a subcohort of out-of-hospital cardiac arrest cases, we also measure the association between patient survival and previous paramedic intubation experience.
  
  
  METHODS
  We analyzed data from Ambulance Victoria electronic patient care records and the Victorian Ambulance Cardiac Arrest Registry for January 1, 2008, to September 26, 2014. For each patient case, we defined intubation experience as the number of intubations attempted by each paramedic in the previous 3 years. Using logistic regression, we estimated the association between intubation experience and (1) successful intubation and (2) first-pass success. In the out-of-hospital cardiac arrest cohort, we determined the association between previous intubation experience and patient survival.
  
  
  RESULTS
  During the 6.7-year study period, 769 paramedics attempted intubation in 14,857 patients. Paramedics typically performed 3 intubations per year (interquartile range 1 to 6). Most intubations were successful (95%), including 80% on the first attempt. Previous intubation experience was associated with intubation success (odds ratio 1.04; 95% confidence interval 1.03 to 1.05) and intubation first-pass success (odds ratio 1.02; 95% confidence interval 1.01 to 1.03). In the out-of-hospital cardiac arrest subcohort (n=9,751), paramedic intubation experience was not associated with patient survival.
  
  
  CONCLUSIONS
  Paramedics in this Australian cohort performed few intubations. Previous experience was associated with successful intubation. Among out-of-hospital cardiac arrest patients for whom intubation was attempted, previous paramedic intubation experience was not associated with patient survival.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Ambulance Victoria, Victoria, Australia. Electronic address: Kylie.dyson@monash.edu.
authors.forename: Kylie
authors.initials: K
authors.lastname: Dyson
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia; School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Bray
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Ambulance Victoria, Victoria, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Ambulance Victoria, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Lahn
authors.initials: L
authors.lastname: Straney
authors.affiliation: Ambulance Victoria, Victoria, Australia.
authors.forename: Resmi
authors.initials: R
authors.lastname: Nair
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, Australia; School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
authors.forename: Judith
authors.initials: J
authors.lastname: Finn
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000401:mortality; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D012042:Registries; D012151:Resuscitation / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology