Rural and Remote Intubations in An Australian Aeromedical Retrieval Service: A Retrospective Cohort Study.

Abstract

Objective Critically unwell patients in rural and remote areas of Queensland, Australia, often require airway management with rapid sequence intubation (RSI) prior to retrieval to a tertiary centre. Retrieval Services Queensland (RSQ) coordinate retrievals and support rural hospitals, including via telehealth. We aimed to describe the demographics of patients intubated in Queensland hospitals requiring subsequent aeromedical retrieval. This retrospective cohort study compared patients intubated by a retrieval team, including a LifeFlight Retrieval Medicine (LRM) doctor, to those intubated by the local hospital team. MethodsRetrospective cohort study of all patients intubated in hospitals in Queensland, Australia, requiring subsequent aeromedical retrieval (including an LRM doctor) between January 2019 and December 2019. Data collected included: time of day, mission priority, geographical location of hospital, rurality, diagnosis, failure/assistance with intubation. Descriptive statistics were complemented by logistic regression analyses. Results In 2019, 684 patients were intubated in hospitals in Queensland, Australia, requiring subsequent aeromedical retrieval by a team including an LRM doctor. 131 (19.2%) were intubated by the retrieval team, and 553 (80.8%) were intubated by the local hospital team. The retrieval team was more likely to intubate as the age of the patient increased. In the most rural and remote areas, 64 (43.2%) of patients were intubated by the retrieval team, compared with 84 (56.8%) by the local team. In this subgroup of rural and remote patients, the composite diagnosis of ‘injuries, poisons, toxicology and drugs’ was significantly more likely to be associated with the local team intubating. ConclusionA retrieval team is more likely to be required for intubation of patients in rural and remote hospitals in Queensland, Australia. Service provision for critically unwell patients, coordinated by RSQ, is effective and well-managed. Rural and remote hospitals should be given special preference and consideration for timely dispatch of the retrieval team for assistance with these cases.Trial RegistrationEthical approval for this project was granted by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee (LNR/2020/QRBW/64917). A waiver of consent was granted given the retrospective and deidentified nature of the study.