Airway management by physician-staffed Helicopter Emergency Medical Services – a prospective, multicentre, observational study of 2,327 patients

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Stephen J.M. Sollid^1,10  Falko Harm^1,12  Tom Silfvast⁶  Bjørn Ole Reid^1,15  Antti Kämäräinen^1,13  Helena Jäntti⁸  Richard Lyon⁷  Akos Soti^1,14  Karl Ove Hufthammer²  Knut Fredriksen⁵  Mårten Sandberg³  Brian Burns^1,11  David Lockey⁹  Jon-Kenneth Heltne⁴  Geir Arne Sunde¹ 

[1]Department of Health Sciences, University of Stavanger, Stavanger, Norway

[2]Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway

[3]Faculty of Medicine, University of Oslo, Oslo, Norway

[4]Department of Medical Sciences, University of Bergen, Bergen, Norway

[5]The University Hospital of North Norway, Tromsø, Norway

[6]University of Helsinki, Helsinki, Finland

[7]Kent, Surrey & Sussex Air Ambulance Trust, Marden, UK

[8]Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland

[9]Institute of Prehospital Care, London’s Air Ambulance, Bartshealth NHS Trust, London, UK

[10]Air Ambulance Department, Oslo University Hospital, Oslo, Norway

[11]Sydney Medical School, University of Sydney, Sydney, Australia

[12]Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland

[13]Emergency Medical Services, Tampere University Hospital, Tampere, Finland

[14]Hungarian Air Ambulance Nonprofit Ltd., Budaors, Hungary

[15]Department of Emergency Medicine and Prehospital Services, St. Olavs Hospital, Trondheim, Norway

关键词: Out-of-hospital cardiac arrest;    Intubation;    Emergency medical services;    Airway management;    Advanced trauma life support;   

Others  :  1222789
DOI  :  10.1186/s13049-015-0136-9

 received in 2015-02-21, accepted in 2015-07-14,  发布年份 2015

【 摘 要 】

Background

Despite numerous studies on prehospital airway management, results are difficult to compare due to inconsistent or heterogeneous data. The objective of this study was to assess advanced airway management from international physician-staffed helicopter emergency medical services.

Methods

We collected airway data from 21 helicopter emergency medical services in Australia, England, Finland, Hungary, Norway and Switzerland over a 12-month period. A uniform Utstein-style airway template was used for collecting data.

Results

The participating services attended 14,703 patients on primary missions during the study period, and 2,327 (16 %) required advanced prehospital airway interventions. Of these, tracheal intubation was attempted in 92 % of the cases. The rest were managed with supraglottic airway devices (5 %), bag-valve-mask ventilation (2 %) or continuous positive airway pressure (0.2 %). Intubation failure rates were 14.5 % (first-attempt) and 1.2 % (overall). Cardiac arrest patients showed significantly higher first-attempt intubation failure rates (odds ratio: 2.0; 95 % CI: 1.5-2.6; p < 0.001) compared to non-cardiac arrest patients. Complications were recorded in 13 %, with recognised oesophageal intubation being the most frequent (25 % of all patients with complications). For non-cardiac arrest patients, important risk predictors for first-attempt failure were patient age (a non-linear association) and administration of sedatives (reduced failure risk). The patient’s sex, provider’s intubation experience, trauma type (patient category), indication for airway intervention and use of neuromuscular blocking agents were not risk factors for first-attempt intubation failure.

Conclusions

Advanced airway management in physician-staffed prehospital services was performed frequently, with high intubation success rates and low complication rates overall. However, cardiac arrest patients showed significantly higher first-attempt failure rates compared to non-cardiac arrest patients. All failed intubations were handled successfully with a rescue device or surgical airway.

Trial registration

Study registration: www.clinicaltrials.govNCT01502111. Registered 22 December 2011.

【 授权许可】

   
2015 Sunde et al.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]Helm M, Hossfeld B, Schafer S, Hoitz J, Lampl L. Factors influencing emergency intubation in the pre-hospital setting--a multicentre study in the German Helicopter Emergency Medical Service. Br J Anaesth. 2006; 96(1):67-71.
• [2]Timmermann A, Eich C, Russo SG, Natge U, Brauer A, Rosenblatt WH et al.. Prehospital airway management: a prospective evaluation of anaesthesia trained emergency physicians. Resuscitation. 2006; 70(2):179-85.
• [3]Lossius HM, Sollid SJ, Rehn M, Lockey DJ. Revisiting the value of pre-hospital tracheal intubation: an all time systematic literature review extracting the Utstein airway core variables. Crit Care. 2011; 15(1):R26. BioMed Central Full Text
• [4]Lecky F, Bryden D, Little R, Tong N, Moulton C. Emergency intubation for acutely ill and injured patients. Cochrane Database Syst Rev. 2008; 2:CD001429.
• [5]Gunning M, O'Loughlin E, Fletcher M, Crilly J, Hooper M, Ellis DY. Emergency intubation: a prospective multicentre descriptive audit in an Australian helicopter emergency medical service. Emerg Med J. 2009; 26(1):65-9.
• [6]Sollid SJ, Lockey D, Lossius HM. Pre-hospital advanced airway management expert g. A consensus-based template for uniform reporting of data from pre-hospital advanced airway management. Scand J Trauma Resusc Emerg Med. 2009; 17:58. BioMed Central Full Text
• [7]von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP et al.. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007; 335(7624):806-8.
• [8]Soti A, Temesvari P, Hetzman L, Eross A, Petroczy A. Implementing new advanced airway management standards in the Hungarian physician staffed Helicopter Emergency Medical Service. Scand J Trauma Resusc Emerg Med. 2015; 23(1):3. BioMed Central Full Text
• [9]Cook TD. Advanced statistics: up with odds ratios! A case for odds ratios when outcomes are common. Acad Emerg Med. 2002; 9(12):1430-4.
• [10]R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing; 2014.
• [11]Bates D MM, Bolker BM, Walker S. Fitting Linear Mixed-Effects Models using lme4. Submitted to Journal of Statistical Software. ArXiv e-print: http://arxiv.org/abs/1406.5823 (2014).
• [12]Adnet F, Cydulka RK, Lapandry C. Emergency tracheal intubation of patients lying supine on the ground: influence of operator body position. Can J Anaesth. 1998; 45(3):266-9.
• [13]Combes X, Jabre P, Jbeili C, Leroux B, Bastuji-Garin S, Margenet A et al.. Prehospital standardization of medical airway management: incidence and risk factors of difficult airway. Acad Emerg Med. 2006; 13(8):828-34.
• [14]Brown CA, Bair AE, Pallin DJ, Walls RM, Investigators NI. Techniques, success, and adverse events of emergency department adult intubations. Ann Emerg Med. 2015; 65(4):363-70.
• [15]Walls RM, Brown CA, Bair AE, Pallin DJ, Investigators NI. Emergency airway management: a multi-center report of 8937 emergency department intubations. J Emerg Med. 2011; 41(4):347-54.
• [16]Nakstad AR, Heimdal HJ, Strand T, Sandberg M. Incidence of desaturation during prehospital rapid sequence intubation in a physician-based helicopter emergency service. Am J Emerg Med. 2011; 29(6):639-44.
• [17]Lockey D, Crewdson K, Weaver A, Davies G. Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians. Br J Anaesth. 2014; 113(2):220-5.
• [18]Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004; 99(2):607-13.
• [19]Rognas L, Hansen TM, Kirkegaard H, Tonnesen E. Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Scand J Trauma Resusc Emerg Med. 2013; 21(1):58. BioMed Central Full Text
• [20]Moon HY, Baek CW, Kim JS, Koo GH, Kim JY, Woo YC et al.. The causes of difficult tracheal intubation and preoperative assessments in different age groups. Korean J Anesthesiol. 2013; 64(4):308-14.
• [21]Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth. 1994; 41(5 Pt 1):372-83.
• [22]Lossius HM, Roislien J, Lockey DJ. Patient safety in pre-hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers. Crit Care. 2012; 16(1):R24. BioMed Central Full Text
• [23]Schmidt UH, Kumwilaisak K, Bittner E, George E, Hess D. Effects of supervision by attending anesthesiologists on complications of emergency tracheal intubation. Anesthesiology. 2008; 109(6):973-7.
• [24]Combes X, Jabre P, Margenet A, Merle JC, Leroux B, Dru M et al.. Unanticipated difficult airway management in the prehospital emergency setting: prospective validation of an algorithm. Anesthesiology. 2011; 114(1):105-10.
• [25]Lockey DJ, Avery P, Harris T, Davies GE, Lossius HM. A prospective study of physician pre-hospital anaesthesia in trauma patients: oesophageal intubation, gross airway contamination and the ‘quick look’ airway assessment. BMC Anesthesiol. 2013; 13(1):21. BioMed Central Full Text
• [26]Lossius HM, Kruger AJ, Ringdal KG, Sollid SJ, Lockey DJ. Developing templates for uniform data documentation and reporting in critical care using a modified nominal group technique. Scand J Trauma Resusc Emerg Med. 2013; 21:80. BioMed Central Full Text