Chest
Volume 85, Issue 3, March 1984, Pages 341-345
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Field Endotracheal Intubation by Paramedical Personnel: Success Rates and Complications

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One-hundred thirty mobile intensive care unit paramedics were trained in the technique of direct laryngoscopic endotracheal intubation of cardiac arrest or deeply comatose patients. Three attempts at intubation were permitted. Of the 779 patients studied, 701 (90.0 percent) were successfully intubated: 57.9 percent on the first attempt, 26.1 percent and 5.5 percent on the second and third respectively. Reported and observed complications of the procedure numbered 74 (9.5 percent) of the 779 patients included in the study. There were three unrecognized esophageal intubations. The success rate rose to more than 94 percent toward the end of the study. It is concluded that endotracheal intubation of deeply comatose patients is a field procedure safely and skillfully performed by well-trained and monitored paramedical personnel, with success and complication rates at least comparable to other invasive airway techniques.

Section snippets

MATERIALS AND METHODS

The city of Pittsburgh’s Emergency Medical Services Department is an agency of municipal government operating 13 mobile intensive care units which respond to over 50,000 calls per year. Physician participation in the system is represented by a medical director, an associate medical director, and 12 emergency medicine residents. Medical control is assured daily through a second or third-year resident directing care either on-scene or by way of portable UHF radio. A faculty member monitors the

Success Rates

The overall success rate for intubation attempts by the 130 paramedical personnel was 90.0 percent (701/779). Analysis of the several years of the study reveals some statistically significant differences in success rates (Table 1). During the first year, groups 1 and 2 were reported to have intubated 242 patients with a success rate of 92.1 percent, a higher success rate than in the following year when all groups were reported to have successfully intubated 86.2 percent of patients (305/354).

DISCUSSION

The controversy surrounding the ability of paramedical personnel to perform orotracheal intubation revolves largely around the belief that this skill may be difficult to learn, that it carries significant risk, and requires frequent practice to maintain an acceptable and safe level of performance. The popularity of the esophageal obturator airway rests largely upon its alleged simplicity and an apparently less-demanding skill of insertion.6, 13

Despite the fact that several large advanced life

ACKNOWLEDGMENTS

The cooperation and enthusiasm of the city of Pittsburgh paramedics, the faculty of the Department of Anesthesiology and the Health Operations Research Group at the University of Pittsburgh, are gratefully acknowledged.

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Supported in part by Research Grant HS03813 (Computerized Prehospital Skill Deployment/Maintenance), National Center for Health Services Research, US Department of Health and Human Services.

Manuscript received June 2; revision accepted September 12.

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