Evaluating the incidence of unrecognised oesophageal intubation by paramedics
Abstract
The maintenance of a patent airway is a requirement for every patient. In the context of critically ill patients, this is frequently achieved by the use of invasive airway devices. Endotracheal intubation (ETI) is considered the ‘gold standard’ of airway management in the hospital setting (Wang, 2007).
ETI is recommended by the Australian Resuscitation Council for airway maintenance and protection during cardiopulmonary resuscitation (Australian Resuscitation Council, 2010). Since the inception of paramedic practice over 30 years ago paramedics have performed ETI. Early research into paramedic pre-hospital ETI focused on skill performance, with research demonstrating ETI success rates of greater than 90% (Jacobs et al. 1983; Stewart et al. 1984).
Since the turn of the century, the performance of pre-hospital ETI by paramedics has come under increasing scrutiny. Researchers have generally found either equivocal or unfavourable outcomes associated with pre-hospital ETI by paramedics (Wang and Yealy, 2006). One possible explanation for these outcomes is the varying rates of adverse events that have been identified as being associated with paramedic pre-hospital ETI. The most serious of these adverse events is an unrecognised oesophageal intubation. The incidence of unrecognised oesophageal intubations by paramedics performing ETI in the pre-hospital setting has been reported to vary from 0–17% (Jacobs et al. 1983; Stewart et al. 1984; Pointer, 1988; Cobas et al. 2009). Intubation is an infrequently performed pre-hospital procedure and is most commonly performed for patients in cardiac arrest (Bendall et al. 2010).
Subscribe to get full access to the Journal of Paramedic Practice
Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.
What's included
-
CPD Focus
-
Develop your career
-
Stay informed