Endotracheal Intubation Success Rate in an Urban, Supervised, Resident-Staffed Emergency Mobile System: An 11-Year Retrospective Cohort Study

doi:10.3390/jcm9010238

. 2020 Jan 16;9(1):238.

doi: 10.3390/jcm9010238.

Endotracheal Intubation Success Rate in an Urban, Supervised, Resident-Staffed Emergency Mobile System: An 11-Year Retrospective Cohort Study

Michèle Chan¹, Christophe A Fehlmann¹, Mathieu Pasquier², Laurent Suppan¹, Georges L Savoldelli^{3

4}

Affiliations

¹ Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, CH-1211 Geneva, Switzerland.
² Emergency Department, Lausanne University Hospital, and University of Lausanne, CH-1011 Lausanne, Switzerland.
³ Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, CH-1211 Geneva, Switzerland.
⁴ Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland.

PMID: 31963162
PMCID: PMC7019886
DOI: 10.3390/jcm9010238

Endotracheal Intubation Success Rate in an Urban, Supervised, Resident-Staffed Emergency Mobile System: An 11-Year Retrospective Cohort Study

Michèle Chan et al. J Clin Med. 2020.

. 2020 Jan 16;9(1):238.

doi: 10.3390/jcm9010238.

Authors

Michèle Chan¹, Christophe A Fehlmann¹, Mathieu Pasquier², Laurent Suppan¹, Georges L Savoldelli^{3

4}

Affiliations

¹ Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, CH-1211 Geneva, Switzerland.
² Emergency Department, Lausanne University Hospital, and University of Lausanne, CH-1011 Lausanne, Switzerland.
³ Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, CH-1211 Geneva, Switzerland.
⁴ Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland.

PMID: 31963162
PMCID: PMC7019886
DOI: 10.3390/jcm9010238

Abstract

Objectives: In the prehospital setting, endotracheal intubation (ETI) is sometimes required to secure a patient's airways. Emergency ETI in the field can be particularly challenging, and success rates differ widely depending on the provider's training, background, and experience. Our aim was to evaluate the ETI success rate in a resident-staffed and specialist-physician-supervised emergency prehospital system.

Methods: This retrospective study was conducted on data extracted from the Geneva University Hospitals' institutional database. In this city, the prehospital emergency response system has three levels of expertise: the first is an advanced life-support ambulance staffed by two paramedics, the second is a mobile unit staffed by an advanced paramedic and a resident physician, and the third is a senior emergency physician acting as a supervisor, who can be dispatched either as backup for the resident physician or when a regular Mobile Emergency and Resuscitation unit (Service Mobile d'Urgence et de Réanimation, SMUR) is not available. For this study, records of all adult patients taken care of by a second- and/or third-level prehospital medical team between 2008 and 2018 were screened for intubation attempts. The primary outcome was the success rate of the ETI attempts. The secondary outcomes were the number of ETI attempts, the rate of ETI success at the first attempt, and the rate of ETIs performed by a supervisor.

Results: A total of 3275 patients were included in the study, 55.1% of whom were in cardiac arrest. The overall ETI success rate was 96.8%, with 74.4% success at the first attempt. Supervisors oversaw 1167 ETI procedures onsite (35.6%) and performed the ETI themselves in only 488 cases (14.9%).

Conclusion: A resident-staffed and specialist-physician-supervised urban emergency prehospital system can reach ETI success rates similar to those reported for a specialist-staffed system.

Keywords: airway management; emergency medical services; endotracheal intubation; prehospital emergency care.

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Conflict of interest statement

The authors declare that they have no competing interests.

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References

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[1] Bulger E.M., Copass M.K., Maier R.V., Larsen J., Knowles J., Jurkovich G.J. An analysis of advanced prehospital airway management. J. Emerg. Med. 2002;23:183–189. doi: 10.1016/S0736-4679(02)00490-0. - DOI - PubMed

[2] Bulger E.M., Copass M.K., Maier R.V., Larsen J., Knowles J., Jurkovich G.J. An analysis of advanced prehospital airway management. J. Emerg. Med. 2002;23:183–189. doi: 10.1016/S0736-4679(02)00490-0. - DOI - PubMed

[3] Benoit J.L., Gerecht R.B., Steuerwald M.T., McMullan J.T. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis. Resuscitation. 2015;93:20–26. doi: 10.1016/j.resuscitation.2015.05.007. - DOI - PubMed

[4] Benoit J.L., Gerecht R.B., Steuerwald M.T., McMullan J.T. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis. Resuscitation. 2015;93:20–26. doi: 10.1016/j.resuscitation.2015.05.007. - DOI - PubMed

[5] Chiang W.C., Hsieh M.J., Chu H.L., Chen A.Y., Wen S.Y., Yang W.S., Chien Y.C., Wang Y.C., Lee B.C., Wang H.C., et al. The effect of successful intubation on patient outcomes after out-of-hospital cardiac arrest in Taipei. Ann. Emerg. Med. 2018;71:387–396. doi: 10.1016/j.annemergmed.2017.08.008. - DOI - PubMed

[6] Chiang W.C., Hsieh M.J., Chu H.L., Chen A.Y., Wen S.Y., Yang W.S., Chien Y.C., Wang Y.C., Lee B.C., Wang H.C., et al. The effect of successful intubation on patient outcomes after out-of-hospital cardiac arrest in Taipei. Ann. Emerg. Med. 2018;71:387–396. doi: 10.1016/j.annemergmed.2017.08.008. - DOI - PubMed

[7] Fouche P.F., Simpson P.M., Bendall J., Thomas R.E., Cone D.C., Doi S.A. Airways in out-of-hospital cardiac arrest: Systematic review and meta-analysis. Prehospital Emerg. Care Off. J. Natl. Assoc. EMS Physicians Natl. Assoc. State EMS Dir. 2014;18:244–256. doi: 10.3109/10903127.2013.831509. - DOI - PubMed

[8] Fouche P.F., Simpson P.M., Bendall J., Thomas R.E., Cone D.C., Doi S.A. Airways in out-of-hospital cardiac arrest: Systematic review and meta-analysis. Prehospital Emerg. Care Off. J. Natl. Assoc. EMS Physicians Natl. Assoc. State EMS Dir. 2014;18:244–256. doi: 10.3109/10903127.2013.831509. - DOI - PubMed

[9] McMullan J., Gerecht R., Bonomo J., Robb R., McNally B., Donnelly J., Wang H.E., CARES Surveillance Group Airway management and out-of-hospital cardiac arrest outcome in the CARES registry. Resuscitation. 2014;85:617–622. doi: 10.1016/j.resuscitation.2014.02.007. - DOI - PubMed

[10] McMullan J., Gerecht R., Bonomo J., Robb R., McNally B., Donnelly J., Wang H.E., CARES Surveillance Group Airway management and out-of-hospital cardiac arrest outcome in the CARES registry. Resuscitation. 2014;85:617–622. doi: 10.1016/j.resuscitation.2014.02.007. - DOI - PubMed

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Endotracheal Intubation Success Rate in an Urban, Supervised, Resident-Staffed Emergency Mobile System: An 11-Year Retrospective Cohort Study

Affiliations

Endotracheal Intubation Success Rate in an Urban, Supervised, Resident-Staffed Emergency Mobile System: An 11-Year Retrospective Cohort Study

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