Role of the Emergency Medicine Physician in Airway Management of the Trauma Patient

Abstract

EM residents and staff can safely manage the airway of trauma patients. There is no statistically significant difference in peri-intubation complications. The complication rate for EDI (33%) and ANI (38%) is higher than reported in the literature, although the populations are not entirely comparable.

Airway Management by US and Canadian Emergency Medicine Residents: A Multicenter Analysis of More Than 6,000 Endotracheal Intubation Attempts

“…6,7 Because of the nonrandomized nature of this study, we have avoided comparing rapid sequence intubation to other techniques of airway management. However, the higher success rates of rapid sequence intubation versus other techniques of airway management in our data are consistent with numerous other studies in the recent literature.…”

Challenges and Advances in Intubation: Airway Evaluation and Controversies with Intubation

“…36 Another large prospective study of ED trauma patient intubations found ''no differences in laryngoscopy performance and intubation success in trauma airways managed.by emergency medicine versus anesthesia residents'' (86.4% versus 89.7% first-attempt success, respectively). 31 In contrast to these studies, [30][31][32][34][35][36] there is one report with slightly different findings. In this study from Scotland, anesthetists had a significantly higher initial success rate (91.8% versus 83.8%) and a better laryngoscopic view (Cormack grades 1 and II) (94.0% versus 89.3%) with a trend to fewer complications (8.7% versus 12.7%) than EPs.…”

“…34 In another study of RSI performed outside ORs on emergency patients, there were no significant differences in the complication rate between three types of intubating teams comprised of anesthetists, nonanesthetists, or both. 35 According to one report, the mean complication rate for ED RSI patients was less for emergency physicians (EPs) than anesthetists.…”

Laryngoscopy Force, Visualization, and Intubation Failure in Acute Trauma

“…In addition, these intubation attempts were made under well-controlled circumstances, in contrast to many acute trauma intubations. 3 Although trauma airway studies in academic centers demonstrate high success rates by anesthesia and emergency physicians, 7,8 this work does not directly support MILS. These studies included penetrating trauma; although clinicians almost certainly used MILS in the blunt trauma cases, it is impossible to know how rigorously they applied the technique.…”

“…These studies included penetrating trauma; although clinicians almost certainly used MILS in the blunt trauma cases, it is impossible to know how rigorously they applied the technique. One of these studies 8 reported that 35% of the patients experienced complications, including hypoxia in 17%. The MILS-associated intubation failures observed by Santoni et al 3 probably explain a significant percentage of the hypoxic events.…”