Advanced airway management success rates in a national cohort of emergency medical services agencies

Resuscitation. 2020 Jan 1;146:43-49. doi: 10.1016/j.resuscitation.2019.11.006. Epub 2019 Nov 20.

Abstract

Objective: Despite its important role in care of the critically ill, there have been few large-scale descriptions of the epidemiology of Emergency Medical Services (EMS) advanced airway management (AAM) and the variations in care with different patient subsets. We sought to characterize AAM performance in a national cohort of EMS agencies.

Methods: We used data from ESO Solutions, Inc., a national EMS electronic health record system. We analyzed EMS emergency patient encounters during 2011-2015 with attempted AAM. We categorized AAM techniques as conventional endotracheal intubation (cETI), neuromuscular blockade assisted intubation (NMBA-ETI), supraglottic airway (SGA), and cricothyroidotomy (needle and open). Determination of successful AAM was based on EMS provider report. We analyzed the data using descriptive statistics, determining the incidence and clinical characteristics of AAM cases. We determined success rates for each AAM technique, stratifying by the subsets cardiac arrest, medical non-arrest, trauma, and pediatrics (age ≤12 years).

Results: AAM occurred in 57,209 patients. Overall AAM success was 89.1% (95% CI: 88.8-89.3%) across all patients and techniques. Intubation success rates varied by technique; cETI (n = 38,004; 76.9%, 95% CI: 76.5-77.3%), NMBA-ETI (n = 6768; 89.7%, 88.9-90.4%). SGAs were used both for initial (n = 9461, 90.1% success, 95% CI: 89.5-90.7%) and rescue (n = 5994, 87.3% success, 95% CI: 86.4-88.1%) AAM. Cricothyroidotomy success rates were low: initial cricothyroidotomy (n = 202, 17.3% success, 95% CI: 12.4-23.3%), rescue cricothyroidotomy (n = 85, 52.9% success, 95% CI: 41.8-88%). AAM success rates varied by patient subset: cardiac arrest (n = 35,782; 91.7%, 95% CI: 91.4-92.0), medical non-arrest (n = 17,086; 84.7%, 84.2-85.2%); trauma (n = 4341; 84.3%, 83.1-85.3%); pediatric (n = 1223; 73.7%, 71.2-76.2%).

Conclusion: AAM success rates varied by airway technique and patient subset. In this national cohort, these results offer perspectives of EMS AAM practices.

Keywords: Airway management; Cardiac arrest; Emergency medical services; Intubation (intratracheal); Paramedics; Pediatrics; Rapid sequence intubation; Trauma.

MeSH terms

  • Airway Management* / methods
  • Airway Management* / statistics & numerical data
  • Child
  • Cohort Studies
  • Electronic Health Records / statistics & numerical data
  • Emergency Medical Services* / methods
  • Emergency Medical Services* / statistics & numerical data
  • Female
  • Heart Arrest* / epidemiology
  • Heart Arrest* / therapy
  • Humans
  • Intubation, Intratracheal* / methods
  • Intubation, Intratracheal* / statistics & numerical data
  • Male
  • Middle Aged
  • Neuromuscular Blockade / methods
  • Neuromuscular Blockade / statistics & numerical data
  • Outcome and Process Assessment, Health Care
  • Resuscitation / methods*
  • Tracheotomy / methods
  • Tracheotomy / statistics & numerical data
  • United States / epidemiology
  • Wounds and Injuries* / epidemiology
  • Wounds and Injuries* / therapy