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Airway status at arrival to the Emergency department among patients with life threatening emergencies

BACKGROUND: Despite the improvement in prehospital care in the last decade in India through dedicated ambulance services, airway management is often performed by undertrained or untrained personnel and remains teetering to the edge of collapse. This study aimed at assessing the airway status in crit...

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Autores principales: Murugan, Sanjay, Kurien, Anju S., Abhilash, Kundavaram Paul Prabhakar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928150/
https://www.ncbi.nlm.nih.gov/pubmed/33681033
http://dx.doi.org/10.4103/jfmpc.jfmpc_1683_20
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author Murugan, Sanjay
Kurien, Anju S.
Abhilash, Kundavaram Paul Prabhakar
author_facet Murugan, Sanjay
Kurien, Anju S.
Abhilash, Kundavaram Paul Prabhakar
author_sort Murugan, Sanjay
collection PubMed
description BACKGROUND: Despite the improvement in prehospital care in the last decade in India through dedicated ambulance services, airway management is often performed by undertrained or untrained personnel and remains teetering to the edge of collapse. This study aimed at assessing the airway status in critically ill patients at their arrival to the Emergency Department (ED). METHODS: This prospective study included all triage priority I patients presenting to the ED during August 2017 and September 2017. Details of their airway status at arrival to the ED was noted. The severity at presentation and outcome of patients brought in ambulances and private vehicles were determined using descriptive analytic statistics and bivariate logistic regression analysis. RESULTS: The study included 450 patients, with a male predominance (65.3%). Only a third (31%) of patients were brought in ambulances with a reminder through various means of transport. Compared to patients brought by private vehicles, patients brought to the ED by ambulances had a higher odds of being hypoxic at ED arrival [OR: 1.63 (95% CI: 1.08–2.46); P value: 0.01] and requiring invasive ventilation on arrival to the ED [OR: 2.36 (95% CI: 1.46–3.80) P value: < 0.001]. Overall, 55.7% (248/450) required hospital admission while 21% (95/450) were discharged stable from the ED after resuscitation and stabilization by the ED team. The overall mortality rate was 11.1% (50/450), with 13.5% (19/144) of those brought by ambulances and 10% (31/309) of those brought by private vehicles succumbing to their illness in the hospital. CONCLUSION: Private vehicles still remain the predominant mode of prehospital transport though ambulances are used to transport sicker patients. More than half the critically ill patients remained hypoxic on arrival to the ED. Our study clearly highlights the glaring deficiency in airway status at ED arrival and stresses the urgent need to improve prehospital care.
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spelling pubmed-79281502021-03-05 Airway status at arrival to the Emergency department among patients with life threatening emergencies Murugan, Sanjay Kurien, Anju S. Abhilash, Kundavaram Paul Prabhakar J Family Med Prim Care Original Article BACKGROUND: Despite the improvement in prehospital care in the last decade in India through dedicated ambulance services, airway management is often performed by undertrained or untrained personnel and remains teetering to the edge of collapse. This study aimed at assessing the airway status in critically ill patients at their arrival to the Emergency Department (ED). METHODS: This prospective study included all triage priority I patients presenting to the ED during August 2017 and September 2017. Details of their airway status at arrival to the ED was noted. The severity at presentation and outcome of patients brought in ambulances and private vehicles were determined using descriptive analytic statistics and bivariate logistic regression analysis. RESULTS: The study included 450 patients, with a male predominance (65.3%). Only a third (31%) of patients were brought in ambulances with a reminder through various means of transport. Compared to patients brought by private vehicles, patients brought to the ED by ambulances had a higher odds of being hypoxic at ED arrival [OR: 1.63 (95% CI: 1.08–2.46); P value: 0.01] and requiring invasive ventilation on arrival to the ED [OR: 2.36 (95% CI: 1.46–3.80) P value: < 0.001]. Overall, 55.7% (248/450) required hospital admission while 21% (95/450) were discharged stable from the ED after resuscitation and stabilization by the ED team. The overall mortality rate was 11.1% (50/450), with 13.5% (19/144) of those brought by ambulances and 10% (31/309) of those brought by private vehicles succumbing to their illness in the hospital. CONCLUSION: Private vehicles still remain the predominant mode of prehospital transport though ambulances are used to transport sicker patients. More than half the critically ill patients remained hypoxic on arrival to the ED. Our study clearly highlights the glaring deficiency in airway status at ED arrival and stresses the urgent need to improve prehospital care. Wolters Kluwer - Medknow 2020-12-31 /pmc/articles/PMC7928150/ /pubmed/33681033 http://dx.doi.org/10.4103/jfmpc.jfmpc_1683_20 Text en Copyright: © 2020 Journal of Family Medicine and Primary Care http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Murugan, Sanjay
Kurien, Anju S.
Abhilash, Kundavaram Paul Prabhakar
Airway status at arrival to the Emergency department among patients with life threatening emergencies
title Airway status at arrival to the Emergency department among patients with life threatening emergencies
title_full Airway status at arrival to the Emergency department among patients with life threatening emergencies
title_fullStr Airway status at arrival to the Emergency department among patients with life threatening emergencies
title_full_unstemmed Airway status at arrival to the Emergency department among patients with life threatening emergencies
title_short Airway status at arrival to the Emergency department among patients with life threatening emergencies
title_sort airway status at arrival to the emergency department among patients with life threatening emergencies
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928150/
https://www.ncbi.nlm.nih.gov/pubmed/33681033
http://dx.doi.org/10.4103/jfmpc.jfmpc_1683_20
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