Field Intubation Aided by Drug Combo

A combination of sedative and paralytic drugs increases the chance of successful intubation outside the hospital by almost a fourfold factor, according to a new study.

The study, involving the air ambulance service of the University of Florida (Gainesville, FL, USA), and the Trauma One flight services of Shands Jacksonville Hospital (Jacksonville, FL, USA), compared laryngoscopy conditions produced by etomidate-only intubation (EOI) with those produced by a combination of etomidate and succinylcholine, known as rapid-sequence intubation (RSI). The study involved 49 patients who were transported over a year's time by two helicopters in the same air ambulance system. For six months, one helicopter's patients were intubated under the EOI protocol alone and the other helicopter's patients were treated using the RSI protocol. For the next six months, the protocols were switched.

For each patient, the crew recorded the airway conditions, such as whether the vocal cords were visible, whether the patient was relaxed, and whether the intubation was successful. The likelihood of successful intubaton was found to be 3.7 times higher with RSI than with EOI. The authors said that the findings may apply to other types of pre-hospital care, including ground ambulances, depending on the experience of the crews. The results were reported in the January to March 2006 edition of Prehospital Emergency Care.

EMS medical directors must carefully match the choice of intubation medications to the training and skill levels of the system's providers, said William Bozeman, M.D., lead author, who is an emergency medicine and pre-hospital emergency medical services (EMS) specialist from Wake Forest University Baptist Medical Center (Winston-Salem, NC, USA). In some systems, using basic oxygen and techniques to keep the airway open, and not attempting intubation, is the safest option for patients. In other systems, with highly skilled and experienced providers who work under close medical oversight, rapid-sequence intubation may be the best choice.



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Wake Forest University Baptist Medical Center