Factors influencing emergency intubation in the pre-hospital setting--a multicentre study in the German Helicopter Emergency Medical Service

Abstract

Background: Definitive airway control by endotracheal intubation (ETI) is standard of care in pre-hospital airway management. However, there are specific factors that may influence and complicate ETI.

Methods: Prospective, descriptive study at three German Helicopter Emergency Medical Services (HEMS) over a 1-yr period. We examined the success and complication rate for field intubation performed by trauma anaesthetists.

Results: In 342 patients (9.3%) ETI was performed. The overall success rate was 100%; in 87.4% the first attempt was successful, whereas in 11.1% a second and in 1.5% a third ETI attempt was necessary. No patient required a surgical intervention. Limited access to the patient was found upon arrival at the scene in 20.2% of the patients and in 9.6% of the patients at the time of ETI attempt. An orotracheal ETI technique was used in all patients. In the patients in whom only one ETI attempt was necessary for successful intubation, the assessment of ETI conditions was rated 'very good' or 'good' in 94.7%, but in those requiring a second or third ETI attempt this was reduced to 68.6 and 20.0%, respectively. Difficulties encountered during ETI included blood (19.9%), vomit/debris (15.8%) and secretions (13.8%) in the upper airway; anatomical reasons (11.7%), patient position (9.6%) and surrounding conditions (9.1%), making laryngoscopy more difficult.

Conclusions: Despite various factors increasing the difficulties in managing the airway in the field, definitive airway control by ETI seems to be safe practice.