Prehospital airway management: A prospective evaluation of anaesthesia trained emergency physicians

Supraglottic airways in difficult airway management: successes, failures, use and misuse

“…There are three main reasons for this: (1) emergency tracheal intubation outside the hospital environment is notably more likely to fail than during elective anaesthesia in hospital; (2) equipment and strategies to manage the difficult airway are limited outside hospital; and (3) direct laryngoscopy is frequently performed by paramedics or emergency medicine physicians who do not practice tracheal intubation on a daily basis [76].…”

“…Other issues complicating airway management of the emergency pre-hospital patient include simultaneous performance of cardiopulmonary resuscitation (CPR) or other medical procedures, altered and varying levels of patient consciousness and lack of trained assistance [77]. As a result, the incidence of difficult laryngoscopy reported by experienced anaesthesiologists during emergency laryngoscopy may be as high as 20% in adult [76] and paediatric [78] patients, much higher than in the operating room [79].…”

“…A high incidence of unrecognised misplaced tubes following intubation by paramedics has also been reported: when the position of tracheal tubes placed out-of-hospital was re-examined by independent observers on arrival in the emergency department, ................................................................................................................................................................................................................... Ó 2011 The Author unrecognised oesophageal or hypopharyngeal intubation was recorded in up to 25% [76,77]. One study also reported an incidence of unrecognised oesophageal intubations of 6.7% when tracheal intubation was performed by emergency medical service physicians [78].…”

Prehospital Airway Management

“…the clinical competence and the experience of the health-care team (Timmermann et al, 2006;Sollid et al 2008) -their technical abilities -the non-technical skills of the emergency team (teamwork)…”

“…Operators and teams which are not competent and experienced enough do not guarantee a prehospital airway management in line with the established standards. This has obvious negative outcomes for the patients themselves, whether they are traumatized or not (Deakin et al, 2009;Warner et al, 2010, Timmermann et al, 2006Fakhry et al, 2006).…”