A before‐and‐after observational study of a protocol for use of the C‐MAC videolaryngoscope with a Frova introducer in pre‐hospital rapid sequence intubation

Abstract

Results using videolaryngoscopy in pre-hospital rapid sequence intubation are mixed. A bougie is not commonly used with videolaryngoscopy. We hypothesised that using videolaryngoscopy and a bougie as core elements of a standardised protocol that includes a drugs and a laryngoscopy algorithm would result in a high first-pass tracheal intubation success rate. We employed videolaryngoscopy (C-MAC) combined with a bougie (Frova intubating introducer) in an anaesthetist-staffed helicopter emergency medical service. Data for adult tracheal intubation were collected prospectively as part of the airway registry of our unit for 22 months after implementation of the protocol (n = 543) and compared with controls (n = 238) treated in the previous year before the implementation. The mean first-pass success rate (95%CI) was 98.2% (96.6-99.0%) in the study group and 85.7% (80.7-89.6%) in the control group, p < 0.0001. Combining C-MAC videolaryngoscopy and bougie with a standardised rapid sequence induction protocol leads to a high first attempt intubation success rate when performed by an anaesthetist-led helicopter emergency medical service team.

44 Do organisational change in out-of-hour service influence on the use of helicopter emergency medical service? an observational study of a natural experiment

“…We recently reported the effect of the protocol on the intubation success rate. 1 The aim of the current study was to describe the methods used during implementation of RSI protocol to the EMS systems and evaluate the protocol compliance and effect on on-scene time (OST). Method The RSI protocol was implemented to the HEMS unit and EMS systems in a three months period in 2015.…”

“…J Karjanlahti*,1 M Tölli, 1 V Lahola, 1 S Länkimäki. 1 Centre for Prehospital Emergency care, The Hospital District of South Ostrobothnia, Seinäjoki, Finland; 2 Vocational Education Centre Sedu, Seinäjoki, Finland 10.1136/10.1136/bmjopen-2018-EMS.45…”

Are bougies gaining favour in videolaryngoscopy?

“…We congratulate Angerman et al for achieving high first-attempt intubation success by combining C-MAC videolaryngoscopy and a Frova intubating introducer during standardised rapid-sequence induction [1]. Please note that a selection of this correspondence will be reproduced (possibly in modified form) in the Journal.…”

“…We would like to ask Angerman et al some questions about their observational study of routine bougie use during videolaryngoscopy [1]. Firstly, do the authors think that their positive findings reflect the benefits of using a bougie with a C-MAC â , or merely the inflexible implementation of a treatment algorithm?…”

Is the C‐MAC videolaryngoscope plus Frova introducer suitable for intubating the trachea of every patient?

“…We congratulate Ångerman et al. for achieving high first‐attempt intubation success by combining C‐MAC videolaryngoscopy and a Frova intubating introducer during standardised rapid‐sequence induction . We would like to ask the authors some questions about their study.…”