Background and Goal of Study: Pre-hospital (PH) emergency in our country is performed by a medical team (MT) (nurse and doctor), activated according emergency algorithms.Tracheal intubation (TI), considered the gold standard in airway management (AM), is sometimes required. TI is frequently performed under poor conditions (space, patient positioning, available materials, nobody to call for help). Skilled and trained professionals in AM are crucial to success. Often these professionals are anesthetists.
The aim of our study was to determine which causes need TI in PH critical patients.
Materials and methods: Prospective audit (june to november 2015) performed in a pre emergency department of a tertiary hospital. Statistical analysis with Microsoft Excel.
Results and discussion: 43 patients were subjected to TI. 65% males, 52% >65 y-old.The main causes of MT activation were cardiopulmonary arrest (CPR) (37.2%) and alteration of level of consciousness (32.6%). Other causes were trauma including cranio encephalic injury(CEI) (11.6%), airway compromise (9.3%), dyspnea (4.7%), syncope (2.3%) and refractory epilepsy (2.3%). On MT arrival, some of these situations had worsened: CPR increased its prevalence to 55.8%, depressed level of consciousness with glasgow coma scale (GCS)< 8 found in 27.9% and CEI with GCS< 8 found in 9.3%. Respiratory distress in 7% patients. All of them were submitted to TI to improve oxigenation/ventilation or for protection of the airway. 93% of these TI were performed by an anesthesiologist or resident of anesthesia with sucess on fisrt attempt in 81% of cases. 2 attempts were the maximum number registered. No rescue supraglottic devices were required. We didn´t find significant complications.
TI remains the gold standard of AM in critical ill patients. Indications to TI are related with problems with airway(A), breathing(B), circulation(C) and disability(D). Problems with C and D were most frequent in our audit. In PH environment conditions for TI are poor which may lead to a higher risk of complications. The great number of anesthetists involved may be an explanation of the low rate of complications found.
Conclusion(s): TI in PH environment is associated with higher risk of complications due to poor conditions for AM. Training performers are essential to increase the success in this setting.
References: Prehospital endotracheal intubation:elemental or detrimental?Pepe et al. Crit Care (2015) 19:121

The challenging of airway management in pre-hospital emergency