Intubation success in prehospital emergency anaesthesia: a retrospective observational analysis of the Inter-Changeable Operator Model (ICOM)
Abstract Background Pre hospital emergency anaesthesia (PHEA) is a complex procedure with significant risks. First-pass intubation success (FPS) is recommended as a quality indicator in pre hospital advanced airway management. Previous data demonstrating significantly lower FPS by non-physicians doe...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13049-022-01032-2 |
| _version_ | 1828774921489088512 |
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| author | James Price Kate Lachowycz Alistair Steel Lyle Moncur Rob Major Ed B. G. Barnard |
| author_facet | James Price Kate Lachowycz Alistair Steel Lyle Moncur Rob Major Ed B. G. Barnard |
| author_sort | James Price |
| collection | DOAJ |
| description | Abstract Background Pre hospital emergency anaesthesia (PHEA) is a complex procedure with significant risks. First-pass intubation success (FPS) is recommended as a quality indicator in pre hospital advanced airway management. Previous data demonstrating significantly lower FPS by non-physicians does not distinguish between non-physicians operating in isolation or within physician teams. In several UK HEMS, the role of the intubating provider is interchangeable between the physician and critical care paramedic—termed the Inter-Changeable Operator Model (ICOM). The objectives of this study were to compare first-pass intubation success rate between physicians and critical care paramedics (CCP) in a large regional, multi-organisational dataset of trauma PHEA patients, and to report the application of the ICOM. Methods A retrospective observational study of consecutive trauma patients ≥ 16 years old who underwent PHEA at two different ICOM Helicopter Emergency Medical Services in the East of England, 2015–2020. Data are presented as number (percentage) and median [inter-quartile range]. Fisher’s exact test was used to compare proportions, reported as odds ratio (OR (95% confidence interval, 95% CI)), p value. The study design complied with the STROBE (Strengthening The Reporting of Observational studies in Epidemiology) reporting guidelines. Results In the study period, 13,654 patients were attended. 674 (4.9%) trauma patients ≥ 16 years old who underwent PHEA were included in the final analysis: the median age was 44 [28–63] years old, and 502 (74.5%) were male. There was no significant difference in the FPS rate between physicians and CCPs—90.2% and 87.4% respectively, OR 1.3 (95% CI 0.7–2.5), p = 0.38. The cumulative first, second, third, and fourth-pass intubation success rates were 89.6%, 98.7%, 99.7%, and 100%. Patients who had a physician-operated initial intubation attempt weighed more and had a higher heart rate, compared to those who had a CCP-operated initial attempt. Conclusion In an ICOM setting, we demonstrated 100% intubation success in adult trauma patients undergoing PHEA. There was no significant difference in first-pass intubation success between physicians and CCPs. |
| first_indexed | 2024-12-11T15:29:55Z |
| format | Article |
| id | doaj.art-1edc3e02e9c9454fbe1e9cb1a5c89018 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-12-11T15:29:55Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-1edc3e02e9c9454fbe1e9cb1a5c890182022-12-22T01:00:05ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412022-07-013011810.1186/s13049-022-01032-2Intubation success in prehospital emergency anaesthesia: a retrospective observational analysis of the Inter-Changeable Operator Model (ICOM)James Price0Kate Lachowycz1Alistair Steel2Lyle Moncur3Rob Major4Ed B. G. Barnard5Department of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Helimed HouseDepartment of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Helimed HouseMagpas Air Ambulance, Centenary HouseDepartment of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Helimed HouseDepartment of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Helimed HouseDepartment of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Helimed HouseAbstract Background Pre hospital emergency anaesthesia (PHEA) is a complex procedure with significant risks. First-pass intubation success (FPS) is recommended as a quality indicator in pre hospital advanced airway management. Previous data demonstrating significantly lower FPS by non-physicians does not distinguish between non-physicians operating in isolation or within physician teams. In several UK HEMS, the role of the intubating provider is interchangeable between the physician and critical care paramedic—termed the Inter-Changeable Operator Model (ICOM). The objectives of this study were to compare first-pass intubation success rate between physicians and critical care paramedics (CCP) in a large regional, multi-organisational dataset of trauma PHEA patients, and to report the application of the ICOM. Methods A retrospective observational study of consecutive trauma patients ≥ 16 years old who underwent PHEA at two different ICOM Helicopter Emergency Medical Services in the East of England, 2015–2020. Data are presented as number (percentage) and median [inter-quartile range]. Fisher’s exact test was used to compare proportions, reported as odds ratio (OR (95% confidence interval, 95% CI)), p value. The study design complied with the STROBE (Strengthening The Reporting of Observational studies in Epidemiology) reporting guidelines. Results In the study period, 13,654 patients were attended. 674 (4.9%) trauma patients ≥ 16 years old who underwent PHEA were included in the final analysis: the median age was 44 [28–63] years old, and 502 (74.5%) were male. There was no significant difference in the FPS rate between physicians and CCPs—90.2% and 87.4% respectively, OR 1.3 (95% CI 0.7–2.5), p = 0.38. The cumulative first, second, third, and fourth-pass intubation success rates were 89.6%, 98.7%, 99.7%, and 100%. Patients who had a physician-operated initial intubation attempt weighed more and had a higher heart rate, compared to those who had a CCP-operated initial attempt. Conclusion In an ICOM setting, we demonstrated 100% intubation success in adult trauma patients undergoing PHEA. There was no significant difference in first-pass intubation success between physicians and CCPs.https://doi.org/10.1186/s13049-022-01032-2Pre hospital careHEMSRSIPHEAIntubation |
| spellingShingle | James Price Kate Lachowycz Alistair Steel Lyle Moncur Rob Major Ed B. G. Barnard Intubation success in prehospital emergency anaesthesia: a retrospective observational analysis of the Inter-Changeable Operator Model (ICOM) Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Pre hospital care HEMS RSI PHEA Intubation |
| title | Intubation success in prehospital emergency anaesthesia: a retrospective observational analysis of the Inter-Changeable Operator Model (ICOM) |
| title_full | Intubation success in prehospital emergency anaesthesia: a retrospective observational analysis of the Inter-Changeable Operator Model (ICOM) |
| title_fullStr | Intubation success in prehospital emergency anaesthesia: a retrospective observational analysis of the Inter-Changeable Operator Model (ICOM) |
| title_full_unstemmed | Intubation success in prehospital emergency anaesthesia: a retrospective observational analysis of the Inter-Changeable Operator Model (ICOM) |
| title_short | Intubation success in prehospital emergency anaesthesia: a retrospective observational analysis of the Inter-Changeable Operator Model (ICOM) |
| title_sort | intubation success in prehospital emergency anaesthesia a retrospective observational analysis of the inter changeable operator model icom |
| topic | Pre hospital care HEMS RSI PHEA Intubation |
| url | https://doi.org/10.1186/s13049-022-01032-2 |
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