Chest
Field Endotracheal Intubation by Paramedical Personnel: Success Rates and Complications
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.
REFERENCES (20)
Emergency endotracheal intubation: who can—who should?
Chest
(1979)- et al.
The esophageal obturator airway: a clinical evaluation
Chest
(1976) A Canadian experience with the esophageal obturator (letter)
JACEP
(1977)- et al.
The esophageal obturator airway: a reassessment of use by paramedics
Ann Emerg Med
(1982) - et al.
Emergency room intubations—complications and survival
Chest
(1979) - et al.
Resuscitation and survival in motor vehicle accidents
J Trauma
(1969) Outside the ivory tower: airway management between accident and hospital
J Trauma
(1972)Training of rescue squads in endotracheal intubation
- et al.
Medic I: The Seattle advanced paramedic training program
- et al.
Evaluation of esophageal obturator airway and endotracheal tube in prehospital cardiac arrest (abstr)
Med Instrum
(1981)
Cited by (209)
Bioinspired robotic exoskeleton for endotracheal intubation
2020, Journal of Materials Research and TechnologyCitation Excerpt :Digital intubation is an alternative strategy to laryngoscopy in performing ETI. It has existed among emergency physicians seeking a “quick and dirty” way to manage airways without the risks involved in using a laryngoscope (e.g. cervical spine injury) or without ability to adequately visualize anatomical features in the presence of bodily fluids (i.e. blood, vomit) [9,10]. The procedure, also known as tactile ETI, involves the provider using their forefinger and middle finger to reach into the oral cavity, palpate the epiglottis at the back of the tongue, and insert the ETT by guiding it along their fingers into the trachea.
Intubation for Out-of-Hospital Cardiac Arrest: The Elephant Is in the Room
2020, Annals of Emergency MedicineCapnography in the Emergency Department: A Review of Uses, Waveforms, and Limitations
2017, Journal of Emergency MedicineUnrecognized failed airway management using a supraglottic airway device
2017, ResuscitationCitation Excerpt :Since the establishment of modern Emergency Medical Services (EMS), endotracheal intubation has been the standard of care for prehospital advanced airway management. Numerous studies have demonstrated that the skill could be performed by paramedics, with success rates comparable to the in-hospital setting [1–4]. More recently, the scientific literature has identified a substantial incidence rate of unrecognized esophageal intubations [5–9], as well as other adverse effects of endotracheal intubation, including peri-intubation hypoxia and bradycardia [10].
The role of prehospital advanced airway management on outcomes for out-of-hospital cardiac arrest patients: a meta-analysis
2016, American Journal of Emergency Medicine
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.