Abstract 290: Out-of-Hospital Airway Management Performance in the United States
Objective: Advanced airway management techniques (endotracheal intubation (ETI), alternate airway insertion (AA) and cricothyroidotomy (CRIC)) are common in out-of-hospital resuscitation. While prior studies describe airway management in single EMS agencies, regions or states, there are no national descriptions. We sought to characterize out-of-hospital advanced airway management success and complications in the United States.
Methods: We used the 2008 National Emergency Medical Services Information System (NEMSIS) data set, containing data from 16 states (AL, CO, FL, HI, IA, ME, MN, MO, NC, ND, NE, NH, NJ, NM, NV, OK). We identified patients receiving advanced airway management, including ETI, AA (Combitube, Laryngeal Mask Airway (LMA), King LT, Esophageal-Obturator Airway (EOA)), and CRIC (needle and open). Rescuers reported airway management success and complications. We examined key subsets (cardiac arrest, non-arrest medical, non-arrest trauma, children <10 years, and rapid-sequence intubation (RSI)). We analyzed the data using descriptive statistics, calculating binomial proportions and odds ratios with 95% confidence intervals.
Results: Among 3,173,361 patients, we used data on 10,356 ETI, 2,246 AA, and 88 CRIC. Per-patient ETI self-reported successes were: overall 6,482/8,418 (77.0%; 95% CI: 76.1–77.9%), cardiac arrest 3,494/4,482 (78.0%; 76.7–79.2%), non-arrest medical 616/846 (72.8%; 69.7–75.8%), non-arrest trauma 417/505 (82.6%; 79.0–85.8%). ETI success was similar for children vs. adults (74.3 vs. 77.3%; OR 0.85, 95% CI: 0.67–1.08). RSI success was 289/255 (81.4%; 77.0–85.3%). AA successes were: overall 1,564/1,794 (87.2%; 95% CI: 85.5–88.7%), Combitube 971/1,162 (83.6%; 81.3–85.6%), LMA 505/530 (95.3%; 93.1–96.9%), EOA 88/104 (84.6%; 76.2–90.9%), King 4/4 (100.0%; 40.0–100.0%). AA success was higher than ETI success (87.2 vs. 77%; OR 2.0, 95% CI: 1.8–2.4). Major complications included: bleeding 84 (0.7%; 95% CI: 0.6–0.9%), vomiting 80 (0.7%; 0.5–0.8%) and esophageal intubation 12 (0.10%; 0.05–0.17%).
Conclusions: In this national series we observed low out-of-hospital airway management success as well as the occurrence of major airway management complications.
- © 2010 by American Heart Association, Inc.