Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service
<p>Abstract</p> <p>Background</p> <p>Anaesthesiologists are airway management experts, which is one of the reasons why they serve as pre-hospital emergency physicians in many countries. However, limited data are available on the actual quality and safety of anaesthesiol...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2010-06-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Online Access: | http://www.sjtrem.com/content/18/1/30 |
| _version_ | 1828422402136080384 |
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| author | Lossius Hans Sollid Stephen JM Søreide Eldar |
| author_facet | Lossius Hans Sollid Stephen JM Søreide Eldar |
| author_sort | Lossius Hans |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Anaesthesiologists are airway management experts, which is one of the reasons why they serve as pre-hospital emergency physicians in many countries. However, limited data are available on the actual quality and safety of anaesthesiologist-managed pre-hospital endotracheal intubation (ETI). To explore whether the general indications for ETI are followed and what complications are recorded, we analysed the use of pre-hospital ETI in severely traumatised patients treated by anaesthesiologists in a Norwegian helicopter emergency medical service (HEMS).</p> <p>Methods</p> <p>A retrospective audit of prospectively registered data concerning patients with trauma as the primary diagnosis and a National Committee on Aeronautics score of 4 - 7 during the period of 1994-2005 from a mixed rural/urban Norwegian HEMS was performed.</p> <p>Results</p> <p>Among the 1255 cases identified, 238 successful pre-hospital ETIs out of 240 attempts were recorded (99.2% success rate). Furthermore, we identified 47 patients for whom ETI was performed immediately upon arrival to the emergency department (ED). This group represented 16% of all intubated patients. Of the ETIs performed in the ED, 43 patients had an initial Glasgow Coma Score (GCS) < 9. Compared to patients who underwent ETI in the ED, patients who underwent pre-hospital ETI had significantly lower median GCS (3 (3-6) vs. 6 (4-8)), lower revised trauma scores (RTS) (3.8 (1.8-5.9) vs. 5.0 (4.1-6.0)), longer mean scene times (23 ± 13 vs. 11 ± 11 min) and longer mean transport times (22 ± 16 vs. 13 ± 14 min). The audit also revealed that very few airway management complications had been recorded.</p> <p>Conclusions</p> <p>We found a very high success rate of pre-hospital ETI and few recorded complications in the studied anaesthesiologist-manned HEMS. However, a substantial number of trauma patients were intubated first on arrival in the ED. This delay may represent a quality problem. Therefore, we believe that more studies are needed to clarify the reasons for and possible clinical consequences of the delayed ETIs.</p> |
| first_indexed | 2024-12-10T15:46:27Z |
| format | Article |
| id | doaj.art-3a4de42174094e13a4688a2b66f0c234 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-12-10T15:46:27Z |
| publishDate | 2010-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-3a4de42174094e13a4688a2b66f0c2342022-12-22T01:42:56ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412010-06-011813010.1186/1757-7241-18-30Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical serviceLossius HansSollid Stephen JMSøreide Eldar<p>Abstract</p> <p>Background</p> <p>Anaesthesiologists are airway management experts, which is one of the reasons why they serve as pre-hospital emergency physicians in many countries. However, limited data are available on the actual quality and safety of anaesthesiologist-managed pre-hospital endotracheal intubation (ETI). To explore whether the general indications for ETI are followed and what complications are recorded, we analysed the use of pre-hospital ETI in severely traumatised patients treated by anaesthesiologists in a Norwegian helicopter emergency medical service (HEMS).</p> <p>Methods</p> <p>A retrospective audit of prospectively registered data concerning patients with trauma as the primary diagnosis and a National Committee on Aeronautics score of 4 - 7 during the period of 1994-2005 from a mixed rural/urban Norwegian HEMS was performed.</p> <p>Results</p> <p>Among the 1255 cases identified, 238 successful pre-hospital ETIs out of 240 attempts were recorded (99.2% success rate). Furthermore, we identified 47 patients for whom ETI was performed immediately upon arrival to the emergency department (ED). This group represented 16% of all intubated patients. Of the ETIs performed in the ED, 43 patients had an initial Glasgow Coma Score (GCS) < 9. Compared to patients who underwent ETI in the ED, patients who underwent pre-hospital ETI had significantly lower median GCS (3 (3-6) vs. 6 (4-8)), lower revised trauma scores (RTS) (3.8 (1.8-5.9) vs. 5.0 (4.1-6.0)), longer mean scene times (23 ± 13 vs. 11 ± 11 min) and longer mean transport times (22 ± 16 vs. 13 ± 14 min). The audit also revealed that very few airway management complications had been recorded.</p> <p>Conclusions</p> <p>We found a very high success rate of pre-hospital ETI and few recorded complications in the studied anaesthesiologist-manned HEMS. However, a substantial number of trauma patients were intubated first on arrival in the ED. This delay may represent a quality problem. Therefore, we believe that more studies are needed to clarify the reasons for and possible clinical consequences of the delayed ETIs.</p>http://www.sjtrem.com/content/18/1/30 |
| spellingShingle | Lossius Hans Sollid Stephen JM Søreide Eldar Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| title | Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service |
| title_full | Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service |
| title_fullStr | Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service |
| title_full_unstemmed | Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service |
| title_short | Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service |
| title_sort | pre hospital intubation by anaesthesiologists in patients with severe trauma an audit of a norwegian helicopter emergency medical service |
| url | http://www.sjtrem.com/content/18/1/30 |
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