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Comparison of tracheal intubation and alternative airway techniques performed in the prehospital setting by paramedics: a systematic review.

https://arctichealth.org/en/permalink/ahliterature144948
Source
CJEM. 2010 Mar;12(2):135-40
Publication Type
Article
Date
Mar-2010
Author
Jan L Jensen
Ka Wai Cheung
John M Tallon
Andrew H Travers
Author Affiliation
Division of Emergency Medical Services, Dalhousie University, Dartmouth, Nova Scotia. jljensen@dal.ca
Source
CJEM. 2010 Mar;12(2):135-40
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Allied Health Personnel
Emergency Medical Services - methods - standards
Humans
Intubation, Intratracheal - standards
Ontario
Professional Competence
Respiration, Artificial - methods - standards
Respiratory Insufficiency - therapy
Abstract
This systematic review included controlled clinical trials comparing tracheal intubation (TI) with alternative airway techniques (AAT) (bag mask ventilation and use of extraglottic devices) performed by paramedics in the prehospital setting. A priori outcomes to be assessed were survival, neurologic outcome, airway management success rates and complications. We identified trials using EMBASE, MEDLINE, CINAHL, The Cochrane Library, Web of Science, author contacts and hand searching. We included 5 trials enrolling a total of 1559 patients. No individual study showed any statistical difference in outcomes between the TI and AAT groups. Because of study heterogeneity, we did not pool the data. This is the most comprehensive review to date on paramedic trials. Owing to the heterogeneity of prehospital systems, administrators of each system must individually consider their airway management protocols.
PubMed ID
20219161 View in PubMed
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On-scene time in advanced trauma life support by anaesthesiologists.

https://arctichealth.org/en/permalink/ahliterature169390
Source
Eur J Emerg Med. 2006 Jun;13(3):156-9
Publication Type
Article
Date
Jun-2006
Author
C Christian S Høyer
Erika F Christensen
Niels T Andersen
Author Affiliation
Department of Anaesthesiology and Intensive Care, Trauma Center Aarhus, Aarhus University Hospital, Aarhus, Denmark. csh@dadlnet.dk
Source
Eur J Emerg Med. 2006 Jun;13(3):156-9
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
Ambulances
Anesthesiology
Denmark
Emergency medical services
Female
Humans
Injury Severity Score
Intubation, Intratracheal - standards - utilization
Male
Prospective Studies
Rescue Work
Respiration, Artificial
Retrospective Studies
Time Factors
Time and Motion Studies
Abstract
Severe injury is the leading cause of death among the young. Trauma systems have improved management of the severely injured and increased survival rates, but there is no level-1 evidence of advanced prehospital trauma care. Advanced prehospital trauma care prolongs on-scene time, which may imply a risk of significant delay in definitive trauma care. The aim of this study was to evaluate on-scene time and influence of (1) the presence of an anaesthesiologist on-scene, (2) prehospital intubation, (3) entrapment, and (4) injury severity.
A cohort of registry-based patients brought to Aarhus Trauma Centre. Data were consecutively reported. On-scene time was defined as the time from vehicle arrival to departure. Severe injury is defined by an injury severity score >15. The study was conducted over the period 1998-2000; only patients brought primarily to the trauma centre were included. Statistical tests used include chi, Kruskal-Wallis, Wilcoxon's rank sum and Spearman's rho.
Seven hundred and forty-one patients triaged to Aarhus Trauma Centre from which we obtained all information in 596 cases constituted the study group. In 472 cases, an anaesthesiologist was present. On-scene times, median and 95% confidence interval, were as follows: entire study group (n=596) 15.5 min (15-17); ambulance only: 14.0 min (12-15); anaesthesiologist present, no intubation, no entrapment: 15.0 min (14-16); intubation, no entrapment: 21.5 min (16-27); entrapment, no intubation: 21.5 min (17-25); both intubation and entrapment: 22.0 min (16-36).
The presence of an anaesthesiologist prolonged the median on-scene time by 1 min and in cases of prehospital intubation by 7.5 min. This result was no different from the prolongation caused by entrapment.
PubMed ID
16679880 View in PubMed
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Paramedic training for proficient prehospital endotracheal intubation.

https://arctichealth.org/en/permalink/ahliterature147069
Source
Prehosp Emerg Care. 2010 Jan-Mar;14(1):103-8
Publication Type
Article
Author
Keir J Warner
David Carlbom
Colin R Cooke
Eileen M Bulger
Michael K Copass
Sam R Sharar
Author Affiliation
Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA. keirw@u.washington.edu
Source
Prehosp Emerg Care. 2010 Jan-Mar;14(1):103-8
Language
English
Publication Type
Article
Keywords
Canada
Clinical Competence
Cohort Studies
Education - organization & administration
Emergency medical services
Emergency Medical Technicians - education
Humans
Intubation, Intratracheal - standards
Prospective Studies
Abstract
Emergency airway management is an important component of resuscitation of critically ill patients. Multiple studies demonstrate variable endotracheal intubation (ETI) success by prehospital providers. Data describing how many ETI training experiences are required to achieve high success rates are sparse.
To describe the relationship between the number of prehospital ETI experiences and the likelihood of success on subsequent ETI and to specifically look at uncomplicated first-pass ETI in a university-based training program with substantial resources.
We conducted a secondary analysis of a prospectively collected cohort of paramedic student prehospital intubation attempts. Data collected on prehospital ETIs included indication, induction agents, number of direct laryngoscopy attempts, and advanced airway procedures performed. We used multivariable generalized estimating equations (GEE) analysis to determine the effect of cumulative ETI experience on first-pass and overall ETI success rates.
Over a period of three years, 56 paramedic students attempted 576 prehospital ETIs. The odds of overall ETI success were associated with cumulative ETI experience (odds ratio [OR] 1.097 per encounter, 95% confidence interval [CI] = 1.026-1.173, p = 0.006). The odds of first-pass ETI success were associated with cumulative ETI experience (OR 1.061 per encounter, 95% CI = 1.014-1.109, p = 0.009).
In a training program with substantial clinical opportunities and resources, increased ETI success rates were associated with increasing clinical exposure. However, first-pass placement of the ETT with a high success rate requires high numbers of ETI training experiences that may exceed the number available in many training programs.
PubMed ID
19947874 View in PubMed
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Review of endotracheal intubations by Ottawa advanced care paramedics in Canada.

https://arctichealth.org/en/permalink/ahliterature150533
Source
Prehosp Emerg Care. 2009 Jul-Sep;13(3):311-5
Publication Type
Article
Author
Ronald K Tam
Justin Maloney
Isabelle Gaboury
Jeannette M Verdon
John Trickett
Shannon D Leduc
Pierre Poirier
Author Affiliation
Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada. rtam@cheo.on.ca
Source
Prehosp Emerg Care. 2009 Jul-Sep;13(3):311-5
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Emergency Medical Technicians
Female
Humans
Infant
Infant, Newborn
Intubation, Intratracheal - standards - statistics & numerical data
Male
Middle Aged
Ontario
Retrospective Studies
Young Adult
Abstract
In the last several years, the National Association of EMS Physicians (NAEMSP) has called for better reporting on prehospital endotracheal intubation (ETI) and has provided guidelines and tools for better systematic review. We sought to evaluate the success of prehospital, non-drug-assisted ETI performed by Ottawa advanced care paramedics (ACPs) based on those guidelines.
A retrospective review was conducted on ETI performed by Ottawa ACPs over a 25-month period to determine the overall success rate of ETI. To qualify our results, descriptive analysis was conducted on demographic data. The relationships between success rate, patient demographic data, and preintubation conditions were examined.
Overall success rate of ACP prehospital, non-drug-assisted ETI was 82.1% (95% confidence interval [CI]: 79.6, 84.3), representing a decreased value in comparison with the 90.7% of the previous study (p
PubMed ID
19499466 View in PubMed
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Scandinavian clinical practice guidelines on general anaesthesia for emergency situations.

https://arctichealth.org/en/permalink/ahliterature141619
Source
Acta Anaesthesiol Scand. 2010 Sep;54(8):922-50
Publication Type
Article
Date
Sep-2010
Author
A G Jensen
T. Callesen
J S Hagemo
K. Hreinsson
V. Lund
J. Nordmark
Author Affiliation
Department of anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark. anders.gadegaard.jensen@ouh.regionsyddanmark.dk
Source
Acta Anaesthesiol Scand. 2010 Sep;54(8):922-50
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Anaphylaxis - prevention & control
Anesthesia, General - standards
Anesthetics - standards
Antacids - therapeutic use
Antiemetics - therapeutic use
Cholinergic Antagonists - therapeutic use
Cricoid Cartilage - physiology
Emergency Medical Services - standards
Fasting
Gastric Acidity Determination
Gastric Emptying - physiology
Humans
Hypnotics and Sedatives
Intubation, Intratracheal - standards
Muscle Relaxants, Central
Narcotics - therapeutic use
Positive-Pressure Respiration
Posture
Preoperative Care
Respiratory Aspiration - epidemiology - prevention & control
Scandinavia
Tidal Volume
Abstract
Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre-operative gastric emptying is rarely indicated. For pre-oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1-1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia.
PubMed ID
20701596 View in PubMed
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Verification of airway management during cardiac arrest: a manikin-based observational study.

https://arctichealth.org/en/permalink/ahliterature96993
Source
Am J Emerg Med. 2010 May;28(4):499-504
Publication Type
Article
Date
May-2010
Author
Masanao Kobayashi
Akira Fujiwara
Hiroshi Morita
Yasuhisa Nishimoto
Takayuki Mishima
Masahiko Nitta
Toshihiro Hotta
Toshimasa Hayashi
Yasuyuki Hayashi
Kenji Sato
Author Affiliation
Department of Emergency Medicine, Osaka Medical College Hospital, Takatsuki-city, Osaka 569-8686, Japan. emm003@poh.osaka-med.ac.jp
Source
Am J Emerg Med. 2010 May;28(4):499-504
Date
May-2010
Language
English
Publication Type
Article
Keywords
Cardiopulmonary Resuscitation - standards
Chest Wall Oscillation
Emergency Medicine - standards
Heart Arrest - therapy
Humans
Intubation, Intratracheal - standards
Laryngoscopy - standards
Manikins
Patient Care Team - standards
Practice Guidelines as Topic
Respiration, Artificial - standards
Time Factors
Abstract
INTRODUCTION: The study aimed to clarify the difficulties concerning insertion of advanced airway devices during cardiac arrest. METHOD: In an observational study using manikins, we examined the airway management techniques of 19 teams at the Osaka Senri medical rally. For ex-post verification, we recorded chest compression and ventilation using the Resusci Anne Advanced Skill Trainer (Laerdal, Norway) and recorded actions of the teams using a video camera. RESULTS: Only a small proportion of teams did not adopt advanced airway management (4 teams, 21.1%). Thirteen teams selected tracheal intubation. None showed chest compression interruptions during intubation manipulation, and the median duration of chest compression interruption during confirmation of postintubation was 6.4 seconds. The median duration of ventilation interruption during intubation was 45.5 seconds. When teams were evaluated for the duration of direct laryngoscopy, that is, so-called duration of intubation, the median duration was 19 seconds, which constituted a large underestimate compared with the duration of ventilation interruption. This represents an underestimation of about 27 seconds. We considered the issues to be identified for shortening the duration of ventilation interruption. CONCLUSION: From this study, it is clear that the strategy of Guideline 2005 that was designed to minimize chest compression interruption has permeated deeply. The recommendation that the duration of intubation manipulation should not exceed 30 seconds has had various interpretations, but it is important to focus on the duration of ventilation interruption.
PubMed ID
20466233 View in PubMed
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7 records – page 1 of 1.