Failed prehospital intubations: an analysis of emergency department courses and outcomes

Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors
H E WangH Rubinstein

Abstract

To examine the reasons for failed prehospital endotracheal intubation (ETI) and to identify how the airway was subsequently managed in the emergency department (ED). Data were collected from January to December 1998 for a county-wide paramedic system. Failed prehospital ETIs and perceived reasons for failure were identified. Subsequent ED airway management was reviewed. During the study period there were 13,112 patient contacts resulting in ETI attempts on 592 patients, of whom 536 (90.5%) were successfully intubated. Of the 56 failed field intubations, 49 (87.5%) had ED charts available for review. Endotracheal intubation failure was associated with inadequate relaxation in 24 (49%), difficult anatomy in ten (20%), and obstruction in five (10%). Successful ETI was achieved in the ED in 42 cases (86%). Twenty cases (41%) were facilitated by rapid-sequence intubation (RSI) in the ED. For those with incomplete relaxation in the field, 13 of 24 (54%) were intubated in the ED using RSI. Factors associated with the use of ED RSI include attempted prehospital nasotracheal intubation or attempted prehospital midazolam-facilitated intubation (p < 0.001). The predicted need for RSI in this prehospital system is approximately 3.9%. In ei...Continue Reading

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Citations

Nov 26, 2003·Current Opinion in Critical Care·Grant V Bochicchio, Thomas M Scalea
Oct 6, 2006·Current Opinion in Anaesthesiology·Marianne Gausche-Hill
Dec 16, 2006·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Francis X GuyetteHenry E Wang
May 29, 2010·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Michael W HubbleMichael E Richards
Apr 5, 2011·Critical Care : the Official Journal of the Critical Care Forum·Daniel P Davis
Jul 15, 2015·CJEM·Justin Mausz, Sheldon Cheskes
Apr 20, 2010·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Jeremy T CushmanManish N Shah
Feb 14, 2012·Critical Care : the Official Journal of the Critical Care Forum·Hans Morten LossiusDavid J Lockey
Nov 13, 2012·Prehospital and Disaster Medicine·Brett WilliamsCoco Giddings
Feb 6, 2016·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Hiromichi NaitoClifton W Callaway
Jun 15, 2006·Prehospital and Disaster Medicine·Thomas R CalkinsMark I Langdorf
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