Abstract 33: The Role of Etomidate in Facilitating Endotracheal Intubation in Patients with Acute Head Injury
Purpose: This study was conducted to determine the effectiveness of etomidate in facilitating endotracheal intubation (ETI) in head injured patients with airway compromise the prehospital setting.
Methods: The setting for this study was a county-wide paramedic service responsible for approximately 26,000 annual calls. Data for all prehospital patients with airway compromise were collected, and included reason for intubation, reason for difficult airway, number of attempts, and success. Patients with airway compromise due to head trauma with a more than 10 minute transport time who were unable to be intubated could be sedated using etomidate. Paramedics recorded whether or not drug-facilitated intubation was performed. Verification of placement was achieved using a combination of techniques, including end-tidal carbon dioxide detection. Patients in cardiac arrest were excluded. Factors that contributed to the inability to intubate following administration of etomidate were recorded. Statistical analysis was performed by determining 95% confidence intervals.
Results: There were a total of 330 patients who met the entry criteria of compromised airway requiring ETI. A total of 58 patients met the screening criteria of live patients with airway compromise who were give etomidate. Of these, 38 of 58 (66%) were successfully intubated, and 18 (30%) were not. No attempts at intubation were made in 2 patients (4%). Patients successfully intubate with etomidate required two or fewer attempts in all cases. Patients who were not able to be intubated following administration of Etomidate were noted to have either clenched jaw (14/18) or intact gag/airway reflexes (4/18) as the reason for inability to intubate.
Conclusions: Etomidate alone is ineffective in nearly on-third of cases of difficult intubation in head injured patients with airway compromise. Clenched jaw or intact gag reflexes were the principal cause of failed intubation following etomidate.