A review of the challenges and solutions during paramedic endotracheal intubation

Prekker, ME, Kwok H, Shin S, Carlbom D, Grabinsky MD, Rea TD (2014) The process of prehospital airway management: Challenges and solutions during paramedic endotracheal intubation. Crit Care Med42(6): 1372–8

This evaluation of pre-hospital airway management within King County, Washington linked prospective airway management registry data with Emergency Medical Service (EMS) records to review challenges and solutions associated with paramedic endotracheal intubation (ETI) in patients aged >12 years during 2006–2011.

Paramedics within this system comprise a relatively small proportion of the total EMS workforce (approximately 150), and are permitted to perform ETI autonomously in cardiac arrest and after medical consultation in non-arrest patients, incorporating drug assisted rapid sequence intubation (RSI) where required. During the study period, paramedics responded as part of a two tier system to 22% of the total EMS activations (n=120 789), with the remainder of these calls handled by basic life support resources alone.

Advanced airway management procedures were attempted in 6.2% (n=7 523) of paramedic activations. The mean ageof patients in whom ETI was attempted was 59 years, and 60% were male. Almost one-in-five (19%) did not survive to hospital admission. Indications for ETI were cardiac arrest (n=2 662, 35%), respiratory failure (n=1 329, 18%), multiple trauma (n=551, 7%), traumatic brain injury (n=446, 6%), and non-traumatic acute neurological decompensation (n=803, 11%).