1. Pre-hospital Advanced Airway Management in the Central Denmark Region
Rognås L 1,2,3,4, Hansen TM 3,4, Kirkegaard H 5, Tønnesen E6
Multiple endotracheal intubation attempts were associated with a two to three-fold increased in the overall incidence of complications
Pre-hospital advanced airway management was withheld in 32.1 % of the cases, most commonly because of the patient’s condition or co-morbidity
The most frequently used alternative treatment was bag-mask ventilation.
Immediate complications related to the decision of not performing pre-hospital advanced airway management occurred in 0.6% of the cases (n=2)
Conclusions
An improved first pass success rate during pre-hospital endotracheal intubation may further reduce the incidences of immediate airway management related complications in our service
Pre-hospital advanced airway management requires advanced critical decision making
References
Rognås L, Hansen TM, Kirkegaard H, Tønnesen E: Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Scandinavian journal of trauma, resuscitation and emergency medicine 2013, 21:58.
Rognås L, Hansen TM, Kirkegaard H, Tønnesen E: Refraining from pre-hospital advanced airway management: a prospective observational study in an anaesthesiologist-staffed pre-hospital critical care service. Scandinavian journal of trauma, resuscitation and emergency medicine 2013, 21:75.
Affiliations
1Department of research and development, Norwegian Air Ambulance Foundation
2Pre-hospital Critical Care Service, Department of Anaesthesiology, Viborg Regional Hospital
3Pre-hospital Critical Care Service Aarhus University Hospital
4Department of Pre-hospital Medical Services, Central Denmark Region
5Centre for Emergency Medicine Research, Aarhus University Hospital
6Department of Anaesthesiology, Aarhus University Hospital
* Systolic blood pressure <90 mmHg
** Oxygen saturation < 90%
Background
Airway management is a vital skill for every pre-hospital critical care practitioner
There are important knowledge gaps regarding the quality of airway management in physician-staffed pre-hospital critical care systems
We present data from one of the first prospective studies conducted according to the Utstein-style template for reporting data from pre-hospital advanced airway management.
Materials and Methods
Prospectively gathered data from consecutive patients of all ages treated by eight anaesthesiologist-staffed pre-hospital critical care teams in the Central Denmark Region.
21 months ( )
Inclution criteria:
patients where pre-hospital advanced airway management were performed or considered but waived
Results
1081 patients included
The overall incidence of successful pre-hospital endotracheal intubation (n=636) was 99.7 %
In total, 22.4 % of the pre-hospital endotracheal intubations required more than one intubation attempt
The overall incidence of complications was 7.9%
No airway management related deaths occurred
Following rapid sequence intubation (RSI)
first-pass success rate was 85.8 %
the overall incidence of complications was 22.0 %
the incidence of post-RSI hypotension* was 7.3%
the incidence of post-RSI hypoxia** was 5.3%