Observational Study

. 2015 Aug 7:23:57.

doi: 10.1186/s13049-015-0136-9.

Airway management by physician-staffed Helicopter Emergency Medical Services - a prospective, multicentre, observational study of 2,327 patients

Geir Arne Sunde^{1

2

3}, Jon-Kenneth Heltne^{4

5}, David Lockey^{6

7}, Brian Burns^{8

9}, Mårten Sandberg^{10

11}, Knut Fredriksen^{12

13}, Karl Ove Hufthammer¹⁴, Akos Soti¹⁵, Richard Lyon^{16

17}, Helena Jäntti¹⁸, Antti Kämäräinen¹⁹, Bjørn Ole Reid²⁰, Tom Silfvast^{21

22}, Falko Harm²³, Stephen J M Sollid^{24

25

26}; Airport Study Group

Collaborators, Affiliations

Collaborators

Airport Study Group:
Akos Soti, Péter Temesvári, Brian Burns, Richard Lyon, David Lockey, Falko Harm, Mathias Zuercher, Helena Jäntti, Tom Silfvast, Antti Kämäräinen, Andreas Jørgensen, Lars Jacobsen, Ann-Elin Tomlinson, Bjørn Ole Reid, Knut Fredriksen, Karl Ove Hufthammer, Mårten Sandberg, Stephen J M Sollid, Geir Arne Sunde

Affiliations

¹ Norwegian Air Ambulance Foundation, Drøbak, Norway. geir.arne.sunde@norskluftambulanse.no.
² Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. geir.arne.sunde@norskluftambulanse.no.
³ Department of Health Sciences, University of Stavanger, Stavanger, Norway. geir.arne.sunde@norskluftambulanse.no.
⁴ Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. jkhe@helse-bergen.no.
⁵ Department of Medical Sciences, University of Bergen, Bergen, Norway. jkhe@helse-bergen.no.
⁶ Department of Health Sciences, University of Stavanger, Stavanger, Norway. david.lockey@nbt.nhs.uk.
⁷ Institute of Prehospital Care, London's Air Ambulance, Bartshealth NHS Trust, London, UK. david.lockey@nbt.nhs.uk.
⁸ Sydney HEMS, Ambulance Service of NSW, Sydney, Australia. bburns_2000@yahoo.com.
⁹ Sydney Medical School, University of Sydney, Sydney, Australia. bburns_2000@yahoo.com.
¹⁰ Air Ambulance Department, Oslo University Hospital, Oslo, Norway. marten.sandberg@medisin.uio.no.
¹¹ Faculty of Medicine, University of Oslo, Oslo, Norway. marten.sandberg@medisin.uio.no.
¹² UiT - The Arctic University of Norway, Tromsø, Norway. Knut.Fredriksen@unn.no.
¹³ The University Hospital of North Norway, Tromsø, Norway. Knut.Fredriksen@unn.no.
¹⁴ Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway. karl.ove.hufthammer@helse-bergen.no.
¹⁵ Hungarian Air Ambulance Nonprofit Ltd., Budaors, Hungary. akossoti@gmail.com.
¹⁶ Emergency Medicine Research Group, Edinburgh, UK. richardl@kssairambulance.org.uk.
¹⁷ Kent, Surrey & Sussex Air Ambulance Trust, Marden, UK. richardl@kssairambulance.org.uk.
¹⁸ Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland. Helena.Jantti@kuh.fi.
¹⁹ Emergency Medical Services, Tampere University Hospital, Tampere, Finland. Antti.Kamarainen@pshp.fi.
²⁰ Department of Emergency Medicine and Prehospital Services, St. Olavs Hospital, Trondheim, Norway. bjorn.ole.reid@stolav.no.
²¹ Emergency Medical Services, Helsinki University Hospital, Helsinki, Finland. Tom.Silfvast@hus.fi.
²² University of Helsinki, Helsinki, Finland. Tom.Silfvast@hus.fi.
²³ Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland. Falko.Harm@usb.ch.
²⁴ Norwegian Air Ambulance Foundation, Drøbak, Norway. stephen.sollid@norskluftambulanse.no.
²⁵ Department of Health Sciences, University of Stavanger, Stavanger, Norway. stephen.sollid@norskluftambulanse.no.
²⁶ Air Ambulance Department, Oslo University Hospital, Oslo, Norway. stephen.sollid@norskluftambulanse.no.

PMID: 26250700
PMCID: PMC4528299
DOI: 10.1186/s13049-015-0136-9

Observational Study

Airway management by physician-staffed Helicopter Emergency Medical Services - a prospective, multicentre, observational study of 2,327 patients

Geir Arne Sunde et al. Scand J Trauma Resusc Emerg Med. 2015.

. 2015 Aug 7:23:57.

doi: 10.1186/s13049-015-0136-9.

Authors

Collaborators

Airport Study Group:
Akos Soti, Péter Temesvári, Brian Burns, Richard Lyon, David Lockey, Falko Harm, Mathias Zuercher, Helena Jäntti, Tom Silfvast, Antti Kämäräinen, Andreas Jørgensen, Lars Jacobsen, Ann-Elin Tomlinson, Bjørn Ole Reid, Knut Fredriksen, Karl Ove Hufthammer, Mårten Sandberg, Stephen J M Sollid, Geir Arne Sunde

Affiliations

¹ Norwegian Air Ambulance Foundation, Drøbak, Norway. geir.arne.sunde@norskluftambulanse.no.
² Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. geir.arne.sunde@norskluftambulanse.no.
³ Department of Health Sciences, University of Stavanger, Stavanger, Norway. geir.arne.sunde@norskluftambulanse.no.
⁴ Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. jkhe@helse-bergen.no.
⁵ Department of Medical Sciences, University of Bergen, Bergen, Norway. jkhe@helse-bergen.no.
⁶ Department of Health Sciences, University of Stavanger, Stavanger, Norway. david.lockey@nbt.nhs.uk.
⁷ Institute of Prehospital Care, London's Air Ambulance, Bartshealth NHS Trust, London, UK. david.lockey@nbt.nhs.uk.
⁸ Sydney HEMS, Ambulance Service of NSW, Sydney, Australia. bburns_2000@yahoo.com.
⁹ Sydney Medical School, University of Sydney, Sydney, Australia. bburns_2000@yahoo.com.
¹⁰ Air Ambulance Department, Oslo University Hospital, Oslo, Norway. marten.sandberg@medisin.uio.no.
¹¹ Faculty of Medicine, University of Oslo, Oslo, Norway. marten.sandberg@medisin.uio.no.
¹² UiT - The Arctic University of Norway, Tromsø, Norway. Knut.Fredriksen@unn.no.
¹³ The University Hospital of North Norway, Tromsø, Norway. Knut.Fredriksen@unn.no.
¹⁴ Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway. karl.ove.hufthammer@helse-bergen.no.
¹⁵ Hungarian Air Ambulance Nonprofit Ltd., Budaors, Hungary. akossoti@gmail.com.
¹⁶ Emergency Medicine Research Group, Edinburgh, UK. richardl@kssairambulance.org.uk.
¹⁷ Kent, Surrey & Sussex Air Ambulance Trust, Marden, UK. richardl@kssairambulance.org.uk.
¹⁸ Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland. Helena.Jantti@kuh.fi.
¹⁹ Emergency Medical Services, Tampere University Hospital, Tampere, Finland. Antti.Kamarainen@pshp.fi.
²⁰ Department of Emergency Medicine and Prehospital Services, St. Olavs Hospital, Trondheim, Norway. bjorn.ole.reid@stolav.no.
²¹ Emergency Medical Services, Helsinki University Hospital, Helsinki, Finland. Tom.Silfvast@hus.fi.
²² University of Helsinki, Helsinki, Finland. Tom.Silfvast@hus.fi.
²³ Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland. Falko.Harm@usb.ch.
²⁴ Norwegian Air Ambulance Foundation, Drøbak, Norway. stephen.sollid@norskluftambulanse.no.
²⁵ Department of Health Sciences, University of Stavanger, Stavanger, Norway. stephen.sollid@norskluftambulanse.no.
²⁶ Air Ambulance Department, Oslo University Hospital, Oslo, Norway. stephen.sollid@norskluftambulanse.no.

PMID: 26250700
PMCID: PMC4528299
DOI: 10.1186/s13049-015-0136-9

Abstract

Background: Despite numerous studies on prehospital airway management, results are difficult to compare due to inconsistent or heterogeneous data. The objective of this study was to assess advanced airway management from international physician-staffed helicopter emergency medical services.

Methods: We collected airway data from 21 helicopter emergency medical services in Australia, England, Finland, Hungary, Norway and Switzerland over a 12-month period. A uniform Utstein-style airway template was used for collecting data.

Results: The participating services attended 14,703 patients on primary missions during the study period, and 2,327 (16 %) required advanced prehospital airway interventions. Of these, tracheal intubation was attempted in 92 % of the cases. The rest were managed with supraglottic airway devices (5 %), bag-valve-mask ventilation (2 %) or continuous positive airway pressure (0.2 %). Intubation failure rates were 14.5 % (first-attempt) and 1.2 % (overall). Cardiac arrest patients showed significantly higher first-attempt intubation failure rates (odds ratio: 2.0; 95 % CI: 1.5-2.6; p < 0.001) compared to non-cardiac arrest patients. Complications were recorded in 13 %, with recognised oesophageal intubation being the most frequent (25 % of all patients with complications). For non-cardiac arrest patients, important risk predictors for first-attempt failure were patient age (a non-linear association) and administration of sedatives (reduced failure risk). The patient's sex, provider's intubation experience, trauma type (patient category), indication for airway intervention and use of neuromuscular blocking agents were not risk factors for first-attempt intubation failure.

Conclusions: Advanced airway management in physician-staffed prehospital services was performed frequently, with high intubation success rates and low complication rates overall. However, cardiac arrest patients showed significantly higher first-attempt failure rates compared to non-cardiac arrest patients. All failed intubations were handled successfully with a rescue device or surgical airway.

Study registration: www.clinicaltrials.gov NCT01502111 . Registered 22 December 2011.

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Figures

**Fig. 2**
Estimated odds ratios for the effect of age on intubation failure on first attempt (ref.: 50 years)

See this image and copyright information in PMC

References

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1. Lossius HM, Sollid SJ, Rehn M, Lockey DJ. Revisiting the value of pre-hospital tracheal intubation: an all time systematic literature review extracting the Utstein airway core variables. Crit Care. 2011;15(1):R26. doi: 10.1186/cc9973. - DOI - PMC - PubMed
1. Lecky F, Bryden D, Little R, Tong N, Moulton C. Emergency intubation for acutely ill and injured patients. Cochrane Database Syst Rev. 2008;2:CD001429. - PMC - PubMed
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Airway management by physician-staffed Helicopter Emergency Medical Services - a prospective, multicentre, observational study of 2,327 patients

Collaborators

Affiliations

Airway management by physician-staffed Helicopter Emergency Medical Services - a prospective, multicentre, observational study of 2,327 patients

Authors

Collaborators

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

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Medical