M Gellerfors1, E Fevang2, A Bäckman3, A Krüger4, S Mikkelsen5, J Nurmi6, L Rognås7, E Sandström8, G Skallsjö9, C Svensén10, D Gryth11, H M Lossius12. 1. Karolinska Institutet, Department of Clinical Science and Education, Section of Anaesthesiology and Intensive Care, Stockholm, Sweden; Swedish Air Ambulance (SLA), Mora, Sweden; Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden; SAE Medevac Helicopter, Swedish Armed Forces, Linköping, Sweden. Electronic address: mikael.gellerfors@ki.se. 2. Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway; Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway. 3. Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden. 4. Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway; Department of Emergency Medicine and Pre-hospital Services, St. Olavs University Hospital Norwegian University of Science and Technology, Trondheim, Norway. 5. Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark. 6. Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland; Department of Emergency Medicine, University of Helsinki, Helsinki, Finland. 7. The Pre-hospital Critical Care Service in Aarhus, Department of Pre-hospital Critical Care Services, Pre-hospital Emergency Medical Service, The Central Denmark Region, Aarhus, Denmark. 8. Helicopter Emergency Medical Service, Region Jämtland Härjedalen, Östersund, Sweden. 9. Helicopter Emergency Medical Service, Västra Götalandsregionen, Gothenburg, Sweden. 10. Karolinska Institutet, Department of Clinical Science and Education, Section of Anaesthesiology and Intensive Care, Stockholm, Sweden; Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden. 11. Department of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden; Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden. 12. Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway; Department of Health Sciences, University of Stavanger, Stavanger, Norway.
Abstract
BACKGROUND: Pre-hospital tracheal intubation success and complication rates vary considerably among provider categories. The purpose of this study was to estimate the success and complication rates of pre-hospital tracheal intubation performed by physician anaesthetist or nurse anaesthetist pre-hospital critical care teams. METHODS: Data were prospectively collected from critical care teams staffed with a physician anaesthetist or a nurse anaesthetist according to the Utstein template for pre-hospital advanced airway management. The patients served by six ambulance helicopters and six rapid response vehicles in Denmark, Finland, Norway, and Sweden from May 2015 to November 2016 were included. RESULTS: The critical care teams attended to 32 007 patients; 2028 (6.3%) required pre-hospital tracheal intubation. The overall success rate of pre-hospital tracheal intubation was 98.7% with a median intubation time of 25 s and an on-scene time of 25 min. The majority (67.0%) of the patients' tracheas were intubated by providers who had performed >2500 tracheal intubations. The success rate of tracheal intubation on the first attempt was 84.5%, and 95.9% of intubations were completed after two attempts. Complications related to pre-hospital tracheal intubation were recorded in 10.9% of the patients. Intubations after rapid sequence induction had a higher success rate compared with intubations without rapid sequence induction (99.4% vs 98.1%; P=0.02). Physicians had a higher tracheal intubation success rate than nurses (99.0% vs 97.6%; P=0.03). CONCLUSIONS: When performed by experienced physician anaesthetists and nurse anaesthetists, pre-hospital tracheal intubation was completed rapidly with high success rates and a low incidence of complications. CLINICAL TRIAL NUMBER: NCT 02450071.
BACKGROUND: Pre-hospital tracheal intubation success and complication rates vary considerably among provider categories. The purpose of this study was to estimate the success and complication rates of pre-hospital tracheal intubation performed by physician anaesthetist or nurse anaesthetist pre-hospital critical care teams. METHODS: Data were prospectively collected from critical care teams staffed with a physician anaesthetist or a nurse anaesthetist according to the Utstein template for pre-hospital advanced airway management. The patients served by six ambulance helicopters and six rapid response vehicles in Denmark, Finland, Norway, and Sweden from May 2015 to November 2016 were included. RESULTS: The critical care teams attended to 32 007 patients; 2028 (6.3%) required pre-hospital tracheal intubation. The overall success rate of pre-hospital tracheal intubation was 98.7% with a median intubation time of 25 s and an on-scene time of 25 min. The majority (67.0%) of the patients' tracheas were intubated by providers who had performed >2500 tracheal intubations. The success rate of tracheal intubation on the first attempt was 84.5%, and 95.9% of intubations were completed after two attempts. Complications related to pre-hospital tracheal intubation were recorded in 10.9% of the patients. Intubations after rapid sequence induction had a higher success rate compared with intubations without rapid sequence induction (99.4% vs 98.1%; P=0.02). Physicians had a higher tracheal intubation success rate than nurses (99.0% vs 97.6%; P=0.03). CONCLUSIONS: When performed by experienced physician anaesthetists and nurse anaesthetists, pre-hospital tracheal intubation was completed rapidly with high success rates and a low incidence of complications. CLINICAL TRIAL NUMBER: NCT 02450071.
Authors: Jürgen Knapp; Bettina Eberle; Michael Bernhard; Lorenz Theiler; Urs Pietsch; Roland Albrecht Journal: Scand J Trauma Resusc Emerg Med Date: 2021-03-17 Impact factor: 2.953
Authors: Pascale Avery; Sarah Morton; James Raitt; Hans Morten Lossius; David Lockey Journal: Scand J Trauma Resusc Emerg Med Date: 2021-05-13 Impact factor: 2.953
Authors: G A Sunde; A Kottmann; J K Heltne; M Sandberg; M Gellerfors; A Krüger; D Lockey; S J M Sollid Journal: Scand J Trauma Resusc Emerg Med Date: 2018-06-04 Impact factor: 2.953