Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Else Tønnesen²  Hans Kirkegaard¹  Troels Martin Hansen³  Leif Rognås³ 

[1] Centre for Emergency Medicine Research, Aarhus University Hospital, Trøjborgvej 72-74, Building 30, 8200 Aarhus, Denmark;Department of Anaesthesiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark;Department of Pre-hospital Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus, Denmark

关键词: Patient safety;    Complications (MeSH);    Difficult endotracheal intubation;    Endotracheal intubation (MeSH);    Airway management (MeSH);    Critical care (MeSH);    Helicopter emergency medical service;    Emergency medical services (MeSH);    Prehospital emergency care (MeSH);    Out-of-hospital;    Pre-hospital;   

Others  :  810874
DOI  :  10.1186/1757-7241-21-58

 received in 2013-05-27, accepted in 2013-07-23,  发布年份 2013

【 摘 要 】

Introduction

We report data from the first Utstein-style study of physician-provided pre-hospital advanced airway management.

Materials and methods

Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region (a mixed rural and urban region with 1.27 million inhabitants) prospectively registered data according to the template for reporting data from pre-hospital advanced airway management. Data collection took place from February 1^st 2011 to October 31^st 2012. Included were patients of all ages on whom pre-hospital advanced airway management was performed. The objective was to estimate the incidences of failed and difficult pre-hospital endotracheal intubation, and complications related to pre-hospital advanced airway management.

Results

The overall incidence of successful pre-hospital endotracheal intubation among 636 intubation attempts was 99.7%, even though 22.4% of pre-hospital endotracheal intubations required more than one intubation attempt. The overall incidence of complications related to pre-hospital advanced airway management was 7.9%. Following rapid sequence intubation, the incidence of first pass success was 85.8%, the overall incidence of complications was 22.0%, the incidence of hypotension 7.3% and that of hypoxia 5.3%. Multiple endotracheal intubation attempts were associated with an increased overall incidence of complications. No airway management related deaths occurred.

Discussion

The overall incidence of successful pre-hospital endotracheal intubations compares to those found in other physician-staffed pre-hospital systems. The incidence of pre-hospital endotracheal intubations requiring more than one attempt is higher than suspected. The incidence of hypotension or hypoxia after pre-hospital rapid sequence intubation compares to those found in UK emergency departments.

Conclusion

Pre-hospital advanced airway management including pre-hospital endotracheal intubation performed by experienced anaesthesiologists is associated with high success rates and relatively low incidences of complications. An increased first pass success rate following pre-hospital endotracheal intubation may further reduce the incidence of complications and enhance patient safety in our system.

【 授权许可】

   
2013 Rognås et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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