Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar 16;11(1):19.
doi: 10.1186/s12245-018-0178-7.

Success rates of pre-hospital difficult airway management: a quality control study evaluating an in-hospital training program

Helmut Trimmel  1   2 , Christoph Beywinkler  3 , Sonja Hornung  3 , Janett Kreutziger  4 , Wolfgang G Voelckel  5   6   7
Affiliations

Success rates of pre-hospital difficult airway management: a quality control study evaluating an in-hospital training program

Helmut Trimmel et al. Int J Emerg Med. .

Abstract

Background: Competence in emergency airway management is key in order to improve patient safety and outcome. The scope of compulsory training for emergency physicians or paramedics is quite limited, especially in Austria. The purpose of this study was to review the difficult airway management performance of an emergency medical service (EMS) in a region that has implemented a more thorough training program than current regulations require, comprising 3 months of initial training and supervised emergency practice and 3 days/month of on-going in-hospital training as previously reported.

Methods: This is a subgroup analysis of pre-hospital airway interventions performed by non-anesthesiologist EMS physicians between 2006 and 2016. The dataset is part of a retrospective quality control study performed in the ground EMS system of Wiener Neustadt, Austria. Difficult airway missions recorded in the electronic database were matched with the hospital information system and analyzed.

Results: Nine hundred thirty-three of 23060 ground EMS patients (4%) required an airway intervention. In 48 cases, transient bag-mask-valve ventilation was sufficient, and 5 patients needed repositioning of a pre-existing tracheostomy cannula. Eight hundred thirty-six of 877 patients (95.3%) were successfully intubated within two attempts; in 3 patients, a supraglottic airway device was employed first line. Management of 41 patients with failed tracheal intubation comprised laryngeal tubes (n = 21), intubating laryngeal mask (n = 11), ongoing bag-mask-valve ventilation (n = 8), and crico-thyrotomy (n = 1). There was no cannot intubate/cannot ventilate situation. Blood gas analysis at admission revealed hypoxemia in 2 and/or hypercapnia in 11 cases.

Conclusion: During the 11-year study period, difficult airways were encountered in 5% but sufficiently managed in all patients. Thus, the training regime presented might be a feasible and beneficial model for training of non-anesthesiologist emergency physicians as well as paramedics.

Keywords: Airway management; Austria; Bag-mask-valve ventilation; Crico-thyrotomy; Difficult airway algorithm; Emergency physician; Prehospital care; Supraglottic airway; Tracheal intubation.

PubMed Disclaimer

Conflict of interest statement

Competing interests

All authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Prehospital Airway Algorithm, Wiener Neustadt Emergency Medical Service
Fig. 2
Fig. 2
Course of Training for non-anaesthesiologist EMS physicians
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Wang HE, Davis DP, Wayne MA, Delbridge T. Prehospital rapid-sequence intubation-what does the evidence show? 2004. pp. 366–377. - PubMed
    1. Lecky F, Bryden D, Little R, Tong N, Moulton C. In: Emergency intubation for acutely ill and injured patients. Lecky F, editor. Chichester: John Wiley & Sons, Ltd; 1996. p. 1. - PMC - PubMed
    1. Fullerton JN, Roberts KJ, Wyse M. Should non-anaesthetists perform pre-hospital rapid sequence induction? An observational study. Emerg Med J. 2011;28(5):428–431. doi: 10.1136/emj.2009.086645. - DOI - PubMed
    1. Trimmel H, Beywinkler C, Hornung S, Kreutziger J, Voelckel WG. In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study. Scand J Trauma Resusc Emerg Med. 2017;25(1):45. doi: 10.1186/s13049-017-0386-9. - DOI - PMC - PubMed
    1. Timmermann A, Eich C, Russo SG, Natge U, Bräuer A, Rosenblatt WH, et al. Prehospital airway management: a prospective evaluation of anaesthesia trained emergency physicians. Resuscitation. 2006;70(2):179–185. doi: 10.1016/j.resuscitation.2006.01.010. - DOI - PubMed

LinkOut - more resources