EMS Pros and Cons of Drug-Assisted Intubation

Excerpt

Airway control is a critical skill for the prehospital healthcare provider. The prehospital provider must be skilled in various methods of airway support ranging from simple airway positioning to the establishment of a definitive airway with an endotracheal tube. Drug-assisted intubation (DAI) is a term used for any use of medications to facilitate endotracheal intubation (ETI), with or without neuromuscular blocking agents. ETI with the use of neuromuscular blockade is known as rapid-sequence intubation (RSI). ETI without the use of neuromuscular blockade is known as sedation-facilitated or medication-facilitated ETI. RSI is the most common type of prehospital DAI performed. Some studies indicate that RSI is more successful than intubation with sedation alone both in the prehospital setting and the emergency department. The use of DAI by emergency medical services (EMS) systems varies throughout the United States. In general, ETI refers to the placement of an endotracheal tube orally. Although nasotracheal intubation is possible, it has largely fallen out of favor in the urgent care setting. In brief, indications for emergency ETI include:

1. Inability to protect the airway

2. Inability to maintain oxygenation and/or ventilation

3. Airway obstruction

4. Current or expected clinical course concerning for airway compromise