A prospective study of physician pre-hospital anaesthesia in trauma patients: oesophageal intubation, gross airway contamination and the ‘quick look’ airway assessment

BMC Anesthesiology

David J Lockey²  Pascale Avery²  Timothy Harris²  Gareth E Davies²  Hans Morten Lossius¹ 

[1] Field of Pre-hospital Critical Care, Network of Medical Sciences, University of Stavanger, Kjell Arholmsgate 41, NO-4036 Stavanger, Norway

[2] London’s Air Ambulance, Department of Pre-hospital Care, Royal London Hospital, London E1 1BB, UK

关键词: Anaesthesia;    Pre-hospital;    Airway;    Tracheal intubation;   

Others  :  816795
DOI  :  10.1186/1471-2253-13-21

 received in 2013-05-12, accepted in 2013-09-03,  发布年份 2013

【 摘 要 】

Background

In trauma patients intubated in a physician-led pre-hospital trauma service we prospectively examined the rate of misplaced tracheal tubes, the presence and nature of gross airway contamination, and the value of ‘quick look’ airway assessment to identify patients with subsequent difficult laryngoscopy.

Methods

Patients requiring pre-hospital intubation in a 16 month period were included. Intubation success rate, misplaced tracheal tube rate, Cormack and Lehane grade, and the presence and nature of gross airway contamination were recorded at laryngoscopy. Tube placement was verified with carbon dioxide detection and chest x-ray. After visual assessment physicians stated whether laryngoscopy was expected to be a straightforward or ‘difficult’. The assessment was compared to subsequent laryngoscopy grade.

Results

400 patients had attempted intubation and 399 were successfully intubated. 42 were in cardiac arrest and intubated without drugs. There were no oesophageal or misplaced tracheal tubes. Gross airway contamination was reported in 177 of 400 patients (44%), of which ¾ was from the upper airway. Unconscious patients had higher contamination rates (57%) than conscious patients (34%) (p ≤ 0.0001). As a test of difficult intubation, the ‘quick look’ generated sensitivity 0.597 and specificity 0.763 (PPV and NPV were 0.336 and 0.904 respectively).

Conclusion

This study suggests that when physicians perform pre-hospital anaesthesia they have high intubation success rates and the use of ETCO2 monitoring reduces or eliminates undetected misplaced tracheal tubes. We found high rates of airway contamination; mostly blood from the upper airway. The ‘quick look’ airway assessment had some utility but is unreliable in isolation.

【 授权许可】

   
2013 Lockey et al.; licensee BioMed Central Ltd.

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