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Determinants of Success and Failure in Prehospital Endotracheal Intubation

INTRODUCTION: This study aimed to identify factors associated with successful endotracheal intubation (ETI) by a multisite emergency medical services (EMS) agency. METHODS: We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics...

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Autores principales: Myers, Lucas A., Gallet, Charles G., Kolb, Logan J., Lohse, Christine M., Russi, Christopher S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017854/
https://www.ncbi.nlm.nih.gov/pubmed/27625734
http://dx.doi.org/10.5811/westjem.2016.6.29969
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author Myers, Lucas A.
Gallet, Charles G.
Kolb, Logan J.
Lohse, Christine M.
Russi, Christopher S.
author_facet Myers, Lucas A.
Gallet, Charles G.
Kolb, Logan J.
Lohse, Christine M.
Russi, Christopher S.
author_sort Myers, Lucas A.
collection PubMed
description INTRODUCTION: This study aimed to identify factors associated with successful endotracheal intubation (ETI) by a multisite emergency medical services (EMS) agency. METHODS: We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth). We analyzed patient and EMS factors affecting ETI. RESULTS: During 12,527 emergent ambulance responses, 200 intubation attempts were made in 150 patients. Intubation was successful in 113 (75%). A crew with paramedics was more than three times as likely to achieve successful intubation as a paramedic/emergency medical technician-Basic crew (odds ratio [OR], 3.30; p=0.03). A small tube (≤7.0 inches) was associated with a more than 4-fold increased likelihood of successful ETI compared with a large tube (≥7.5 inches) (OR, 4.25; p=0.01). After adjustment for these features, compared with little or no view of the glottis, a partial or entire view of the glottis was associated with a nearly 13-fold (OR, 12.98; p=0.001) and a nearly 40-fold (OR, 39.78; p<0.001) increased likelihood of successful intubation, respectively. CONCLUSION: Successful ETI was more likely to be accomplished when a paramedic was partnered with another paramedic, when some or all of the glottis was visible and when a smaller endotracheal tube was used.
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spelling pubmed-50178542016-09-13 Determinants of Success and Failure in Prehospital Endotracheal Intubation Myers, Lucas A. Gallet, Charles G. Kolb, Logan J. Lohse, Christine M. Russi, Christopher S. West J Emerg Med Prehospital Care INTRODUCTION: This study aimed to identify factors associated with successful endotracheal intubation (ETI) by a multisite emergency medical services (EMS) agency. METHODS: We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth). We analyzed patient and EMS factors affecting ETI. RESULTS: During 12,527 emergent ambulance responses, 200 intubation attempts were made in 150 patients. Intubation was successful in 113 (75%). A crew with paramedics was more than three times as likely to achieve successful intubation as a paramedic/emergency medical technician-Basic crew (odds ratio [OR], 3.30; p=0.03). A small tube (≤7.0 inches) was associated with a more than 4-fold increased likelihood of successful ETI compared with a large tube (≥7.5 inches) (OR, 4.25; p=0.01). After adjustment for these features, compared with little or no view of the glottis, a partial or entire view of the glottis was associated with a nearly 13-fold (OR, 12.98; p=0.001) and a nearly 40-fold (OR, 39.78; p<0.001) increased likelihood of successful intubation, respectively. CONCLUSION: Successful ETI was more likely to be accomplished when a paramedic was partnered with another paramedic, when some or all of the glottis was visible and when a smaller endotracheal tube was used. Department of Emergency Medicine, University of California, Irvine School of Medicine 2016-09 2016-07-26 /pmc/articles/PMC5017854/ /pubmed/27625734 http://dx.doi.org/10.5811/westjem.2016.6.29969 Text en © 2016 Myers et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Prehospital Care
Myers, Lucas A.
Gallet, Charles G.
Kolb, Logan J.
Lohse, Christine M.
Russi, Christopher S.
Determinants of Success and Failure in Prehospital Endotracheal Intubation
title Determinants of Success and Failure in Prehospital Endotracheal Intubation
title_full Determinants of Success and Failure in Prehospital Endotracheal Intubation
title_fullStr Determinants of Success and Failure in Prehospital Endotracheal Intubation
title_full_unstemmed Determinants of Success and Failure in Prehospital Endotracheal Intubation
title_short Determinants of Success and Failure in Prehospital Endotracheal Intubation
title_sort determinants of success and failure in prehospital endotracheal intubation
topic Prehospital Care
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017854/
https://www.ncbi.nlm.nih.gov/pubmed/27625734
http://dx.doi.org/10.5811/westjem.2016.6.29969
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