Physician-Led Prehospital Airway Management in Trauma
R. Eleanor Anderson, MD, Ron M. Walls, MD, FRCPC, FAAEM
Intubation was successful in 99% of patients, and all surgical airways were successful in this large retrospective series.
To assess airway management of trauma patients in a physician-led prehospital system in England, researchers conducted a retrospective database review of 7256 prehospital trauma intubations from 1991 to 2012.
Forty-six patients (0.6%) received primary surgical cricothyroidotomy. Of the remaining patients, intubation was successful in 99.3%. Among the 52 patients who could not be intubated, 42 (80.7%) underwent rescue cricothyroidotomy; 9 had a supraglottic airway placed, with 2 subsequently receiving a cricothyroidotomy; and 1 breathed with support of a bag-valve-mask. Nonanesthetist physicians had a statistically higher rate of failed intubation than anesthetists (0.9% vs. 0.4%) and were twice as likely to perform a rescue airway intervention. All cricothyroidotomies provided successful ventilation. There were 18 survivors (20%) in the cricothyroidotomy group, and no difference in survival between patients who underwent primary versus rescue cricothyroidotomy.
Comment: Physicians don’t manage airways in most North American out-of-hospital settings, so comparisons are difficult. Increasing use of supraglottic airways and improved laryngoscope technology should further decrease the need for a surgical airway. Regardless, emergency cricothyroidotomy remains an essential, if infrequently performed, maneuver in the management of the failed airway.
Lockey D et al. Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians. Br J Anaesth 2014 Aug 15; 113:220. (http://dx.doi.org/10.1093/bja/aeu227)
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