Out-of-hospital succinylcholine-assisted endotracheal intubation by paramedics

Pace, Steven; Fuller, Frederick P.

doi:10.1016/s0196-0644(00)70029-1

Cited by 52 publications

(13 citation statements)

References 14 publications

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“…Reports from the State of Washington, however, where paramedics have undertaken succinylcholine-assisted intubations for at least two decades, are encouraging with a success rate of 95.5% (55). Another group has reported a success rate of 92% (59). In EMS systems where the paramedics are permitted to use sedatives, but not neuromuscular blocking agents, the reported success rates are lower (62.5-85%) (60,61).…”

Section: Use Of Neuromuscular Blocking Agentsmentioning

confidence: 99%

Pre‐hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine

Berlac

Hyldmo

Kongstad³

et al. 2008

Acta Anaesthesiol Scand

111

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This article is intended as a generic guide to evidencebased airway management for all categories of pre-hospital personnel. It is based on a review of relevant literature but the majority of the studies have not been performed under realistic, pre-hospital conditions and the recommendations are therefore based on a low level of evidence (D). The advice given depends on the qualifications of the personnel available in a given emergency medical service (EMS). Anaesthetic training and routine in anaesthesia and neuromuscular blockade is necessary for the use of most techniques in the treatment of patients with airway reflexes. For anaesthesiologists, the Task Force commissioned by the Scandinavian Society of Anaesthesia and Intensive Care Medicine recommends endotracheal intubation (ETI) following rapid sequence induction when securing the pre-hospital airway, although repeated unsuccessful intubation attempts should be avoided independent of formal qualifications. Other physicians, as well as paramedics and other EMS personnel, are recommended the lateral trauma recovery position as a basic intervention combined with assisted mask-ventilation in trauma patients. When performing advanced cardiopulmonary resuscitation, we recommend that non-anaesthesiologists primarily use a supraglottic airway device. A supraglottic device such as the laryngeal tube or the intubation laryngeal mask should also be available as a backup device for anaesthesiologists in failed ETI. Accepted for publication 25 February 2008Key words: Pre-hospital; airway management; endotracheal intubation; laryngeal mask airway; laryngeal tube airway; combitube; emergency medical systems. Purpose T HIS article is intended as a guide to evidencebased pre-hospital airway management. The available litterature on pre-hospital airway management reflects vast differences in pre-hospital emergency medicine service (EMS) organisation, qualification levels, training programmes and even terminology. These differences make comparisons between systems and treatment protocols difficult at best. The conduct of clinical trials in pre-hospital airway management is hampered by the 2001/20/ EC directive of the European Parliament concerning informed consent. This paper describes selected equipment and techniques available for pre-hospital airway management. Advice given differs, depending on which category of personnel is available in a given EMS. Our baseline assumption is that a certain level of education and training is necessary for the safe use of a specific technique. Distinction must be made between personnel trained and experienced in providing and monitoring anaesthesia and other groups of personnel with limited or no anaesthetic skills. This distinction dictates which drugs and equipment that should be available in the prehospital setting. Differences between regions and systemsParamedic-based systems are the rule in the United States, whereas physician-based pre-hospital systems are common in Europe. Ideally, the best person to manage the pre-hospital airwa...

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Section: Use Of Neuromuscular Blocking Agentsmentioning

confidence: 99%

Pre‐hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine

Berlac

Hyldmo

Kongstad³

et al. 2008

Acta Anaesthesiol Scand

111

View full text Add to dashboard Cite

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“…These aggressive early airway management protocols have resulted in an increase in the percentage of TBI patients who arrive with a secure airway, especially with the use of neuromuscular blocking agents as part of a rapid sequence intubation (RSI) protocol (11)(12)(13)(14)(15)(16)(17)(18)(19). Thus, the association between prehospital intubation and increased mortality is somewhat surprising (5, 7, 20 -22).…”

mentioning

confidence: 99%

Early ventilation and outcome in patients with moderate to severe traumatic brain injury*

Davis

Idris

Sise

et al. 2006

Critical Care Medicine

161

121

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“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Success rates of 76% to 98% and cricothyrotomy rates of 0% to 4.8% have been reported for prehospital RSI performed by non-physicians. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The accuracy of reported success rates in many of these reports may be limited by the fact that intubator self-reporting or retrospective ED chart review without capnographic waveform analysis was often used to confirm tube placement. [3][4][5][6][7][8][9][10][11][12][13][14][15][16]…”

Section: Discussionmentioning

confidence: 99%

“…23,24 In contrast, published studies of prehospital systems using RSI have no set RSI performance standard or at most 12-20 supervised intubations before allowing independent paralytic use with a prerequisite of varying years of undefined prehospital "experience," usually with no specific number of intubations prior to beginning RSI training. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] It is possible that those EMS agencies with near 100% RSI success have extensive experience (>90 intubations/provider), while those with less success do not meet this cut-off. Importantly, the specific cutoff of 20 intubations cited as RSI experience by prehospital systems corresponds to a mean intubation success rate of only 65-70% for anesthesiology residents.…”

Section: Discussionmentioning

confidence: 99%

“…These requirements meet or exceed those of most published studies of prehospital RSI. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Furthermore, there are no state or national regulations that require a set number of intubations or protocols (e.g., medications, end-tidal CO 2 confirmation, rescue equipment and techniques) that must be followed for prehospital RSI. Florida state statutes delegate the authority of each agency medical director to create protocols and standing orders without state oversight.…”

Section: Discussionmentioning

confidence: 99%

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P Reventable M Orbidity and M Ortality From P Rehospital P Aralytic a Ssisted I Ntubation : C an W E E Xpect O Utcomes C Omparable to H Ospital-Based P Ractice ?

Mizelle

Rothrock

Silvestri

et al. 2002

Prehospital Emergency Care

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The use of prehospital rapid-sequence intubation (RSI) has become an accepted regimen in many parts of the United States, with 29 of 50 states reporting RSI use in 1996 and 1997. 1 The National Association of EMS Physicians states that "the scope of modern prehospital medicine may include rapid-sequence intubation and the use of neuromuscular-blocking agents to facilitate ETI (endotracheal intubation)." 2 The three cases we describe below illustrate the potential for severe morbidity and mortality with prehospital RSI. CASE REPORTS Case 1A 36-year-old man suffered a flash burn from a propane gas line explosion. On emergency medical services (EMS) arrival, the patient was awake and alert, and had no respiratory difficulty, a Glasgow Coma Scale score (GCS) of 15, and "full recall of events." The patient denied loss of consciousness and had clear speech. Lip swelling with seconddegree burns to the left forearm was noted. There was no stridor or wheezing. Initial vital signs were a blood pressure of 161/111 mm Hg, pulse 74 beats/min, and respiratory rate 22 breaths/min with an oxygen saturation of 100%. The EMS air crew performed RSI using etomidate and succinylcholine, reportedly to protect the patient's airway due to their concern for impending airway swelling. After three unsuccessful intubation attempts, the patient was bag--mask-ventilated until spontaneous respirations returned.On emergency department (ED) arrival, the patient awoke and began to speak. Initial vital signs were a blood pressure of 160/104 mm Hg, heart rate of 90 beats/min, respiratory rate of 20 breaths/min, and oxygen saturation of 100% on 2 liters per nasal cannula. Examination revealed partial-thickness burns on his lips and nose without singing of nasal hairs. His eyebrows and some facial hair were singed but there were no other burns on his face. His total face and forearm burns comprised 3% total body surface area. The patient complained of severe dysphagia, mouth pain, and throat pain; however, there were no intraoral burns and no carbonaceous sputum. Direct examination revealed multiple contusions and bleeding of the oropharynx and hypopharynx. Cervical spine films showed a large amount of air in the prevertebral soft tissues. Chest radiography revealed a pneumomediastinum and pneumopericardium with clear lungs and no pneumothorax. The surgical burn unit attending felt that all burn injuries could be managed on an outpatient basis; however, the patient was admitted for evaluation of airway trauma. Subsequent gastrograffin and barium esophagrams revealed no perforation. Prophylactic antibiotics were initiated for a presumed microscopic esophageal tear until the patient's symptoms improved with discharge six days later. Case 2A 42-year-old man was an ejected unrestrained driver of a truck involved in a head-on collision. The patient initially had clear speech and was able to independently maintain his airway. Facial contusions, lacerations, and abrasions were noted. Suctioning was required to clear his airway, and his oxygen saturation w...

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Out-of-hospital succinylcholine-assisted endotracheal intubation by paramedics

Cited by 52 publications

References 14 publications

Pre‐hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine

Pre‐hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine

Early ventilation and outcome in patients with moderate to severe traumatic brain injury*

P Reventable M Orbidity and M Ortality From P Rehospital P Aralytic a Ssisted I Ntubation : C an W E E Xpect O Utcomes C Omparable to H Ospital-Based P Ractice ?

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