The Accuracy of Endotracheal Intubation by Pre-Hospital Emergency Personnel; a Cross-Sectional Study
Iranian Journal of Emergency Medicine,
Vol. 6 No. 1 (2019),
Introduction: Endotracheal intubation is one of the most common measures for airway management in patients with cardiac arrest and decreased consciousness. Therefore, this study was designed to investigate the rate of correct endotracheal intubation by pre-hospital emergency personnel. Methods: In this cross-sectional study, patients who were intubated by pre-hospital emergency personnel outside the hospital and then transferred to the emergency departments of Loghman Hakim, Imam Hossein and Shohadaye Tajrish hospitals from March 2018 to March 2019 were studied regarding the accuracy of intubation. Results: 41 patients with mean age of 64.39 ± 18.64 years (range = 2 to 98) years who were intubated and referred to the emergency department by pre-hospital emergency were studied (73.2% male). The average work experience of the evaluated personnel and the mean years of their training were 7.41 ± 2.70 (range = 15 to 3) years and 1.61 ± 1.74 (range = 0 to 5) years, respectively. The mean distance from place of intubation to the emergency department was 30.48 ± 13.21 (range = 10 to 50) Km. Accuracy of intubation was confirmed in 38 (92.7%) cases. There was no significant relationship between the accuracy of intubation and patient’s sex (p = 0.792), patient’s age (p = 0.639), place of intubation (p = 0.216), time of intubation (p = 0.422), patient’s distance to hospital (p = 0.080), cause of intubation (p = 0.755), patient’s circulation status (p = 0.767), staff’s work experience (p = 0.958), staff’s training (p = 0.536), or educational level of the intubator (p = 0.343). Conclusion: The rate of incorrect intubation by the pre-hospital emergency staff was estimated to be 7.3%. None of the factors, including patient’s sex, patient’s age, place of intubation, time of intubation, patient's distance to hospital, cause of intubation, patient's circulation status, staff’s experience, staff’s training, and intubator’s educational level, significantly correlated with accuracy of intubation.
- Intubation, intratracheal
- emergency medical services
- cardiopulmonary resuscitation
How to Cite
Stevenson, A., et al., Tracheal intubation in the emergency department: the Scottish district hospital perspective. Emergency Medicine Journal, 2007. 24(6): p. 394-397.
Rom, M., Airway. Marx J, Hockberger R, Walls R. Rosen΄ s Emergency Medicine, 6th ed. Philadelphia: Mosby, 2006: p. 2-25.
Danzl, D.F. and R.J. Vissers, Tracheal intubation and mechanical ventilation. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill, 2004. 117.
Sakles, J.C., et al., Airway management in the emergency department: a one-year study of 610 tracheal intubations. Annals of emergency medicine, 1998. 31(3): p. 325-332.
Simpson, J., P. Munro, and C. Graham, Rapid sequence intubation in the emergency department: 5 year trends. Emergency Medicine Journal, 2006. 23(1): p. 54-56.
Griesdale, D.E., et al., Complications of endotracheal intubation in the critically ill. Intensive care medicine, 2008. 34(10): p. 1835-1842.
Sollid, S.J., H.M. Lossius, and E. Søreide, Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service. Scandinavian journal of trauma, resuscitation and emergency medicine, 2010. 18(1): p. 30.
Liberman, M., et al., Multicenter Canadian study of prehospital trauma care. Annals of surgery, 2003. 237(2): p. 153.
Timmermann, A., et al., The out-of-hospital esophageal and endobronchial intubations performed by emergency physicians. Anesthesia & Analgesia, 2007. 104(3): p. 619-623.
Mort, T.C., Complications of emergency tracheal intubation: hemodynamic alterations-part I. Journal of intensive care medicine, 2007. 22(3): p. 157-165.
Wang, H.E., et al., Outcomes after out-of-hospital endotracheal intubation errors. Resuscitation, 2009. 80(1): p. 50-55.
Jaber, S., et al., Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Critical care medicine, 2006. 34(9): p. 2355-2361.
Schmidt, U.H., et al., Effects of supervision by attending anesthesiologists on complications of emergency tracheal intubation. Anesthesiology: The Journal of the American Society of Anesthesiologists, 2008. 109(6): p. 973-977.
Pham, T., L.J. Brochard, and A.S. Slutsky. Mechanical ventilation: state of the art. in Mayo Clinic Proceedings. 2017. Elsevier.
Sen, A. and R. Nichani, Prehospital endotracheal intubation in adult major trauma patients with head injury. Emergency Medicine Journal, 2005. 22(12): p. 887-889.
Bochicchio, G.V., et al., Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury. Journal of Trauma and Acute Care Surgery, 2003. 54(2): p. 307-311.
Mort, T.C., Complications of emergency tracheal intubation: immediate airway-related consequences: part II. Journal of intensive care medicine, 2007. 22(4): p. 208-215.
Schwartz, D.E., M.A. Matthay, and N.H. Cohen, Death and other complications of emergency airway management in critically ill adults a prospective investigation of 297 tracheal intubations. Anesthesiology: The Journal of the American Society of Anesthesiologists, 1995. 82(2): p. 367-376.
Breckwoldt, J., et al., Expertise in prehospital endotracheal intubation by emergency medicine physicians—comparing ‘proficient performers’ and ‘experts’. Resuscitation, 2012. 83(4): p. 434-439.
Konrad, C., et al., Learning manual skills in anesthesiology: is there a recommended number of cases for anesthetic procedures? Anesthesia & Analgesia, 1998. 86(3): p. 635-639.
Wang, H.E., et al., Out-of-hospital airway management in the United States. Resuscitation, 2011. 82(4): p. 378-385.
Diggs, L.A., J.-E.W. Yusuf, and G. De Leo, An update on out-of-hospital airway management practices in the United States. Resuscitation, 2014. 85(7): p. 885-892.
Prekker, M.E., et al., The process of prehospital airway management: challenges and solutions during paramedic endotracheal intubation. Critical care medicine, 2014. 42(6): p. 1372.
Wang, H.E., et al., Paramedic intubation errors: isolated events or symptoms of larger problems? Health Affairs, 2006. 25(2): p. 501-509.
El-Menyar, A., et al., Age and traumatic chest injury: a 3-year observational study. European Journal of Trauma and Emergency Surgery, 2013. 39(4): p. 397-403.
Herff, H., V. Wenzel, and D. Lockey, Prehospital intubation: the right tools in the right hands at the right time. 2009, LWW.
Mort, T.C., Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesthesia & Analgesia, 2004. 99(2): p. 607-613.
Al-Thani, H., A. El-Menyar, and R. Latifi, Prehospital versus emergency room intubation of trauma patients in Qatar: a-2-year observational study. North American journal of medical sciences, 2014. 6(1): p. 12.
Jones, J.H., et al., Emergency physician–verified out‐of‐hospital intubation: miss rates by paramedics. Academic Emergency Medicine, 2004. 11(6): p. 707-709.
Chesters, A., et al., Prehospital anaesthesia performed in a rural and suburban air ambulance service staffed by a physician and paramedic: a 16-month review of practice. Emerg Med J, 2014. 31(1): p. 65-68.
Soti, A., et al., Implementing new advanced airway management standards in the Hungarian physician staffed Helicopter Emergency Medical Service. Scandinavian journal of trauma, resuscitation and emergency medicine, 2015. 23(1): p. 3.
Nolan, J.P., et al., European Resuscitation Council and European Society of Intensive Care Medicine guidelines for post-resuscitation care 2015: section 5 of the European Resuscitation Council guidelines for resuscitation 2015. Resuscitation, 2015. 95: p. 202-222.
- Abstract Viewed: 1006 times
- PDF (فارسی) Downloaded: 129 times
- HTML (فارسی) Downloaded: 28 times