What happens with failed blind nasal tracheal intubations?

Area of Science:

• Emergency Medicine
• Airway Management
• Pre-hospital Care

Background:

• Blind nasal tracheal intubation (BNTI) is an airway management technique used by flight nurses and paramedics.
• Limited research exists on BNTI failure rates and associated demographic factors.
• No studies have evaluated the success rates of subsequent oral tracheal intubation (OTI) and cricothyroidotomy (cric) after failed BNTI.

Purpose of the Study:

• To identify factors associated with BNTI failure in air medical settings.
• To determine the failure rates of OTI and cric performed after failed BNTI by flight personnel.

Main Methods:

• Retrospective review of BNTI, OTI, and cric attempts by flight nurses and paramedics in 1999.
• Statistical analysis (t-test, chi-squared) to compare demographic factors (age, gender, illness type, setting, provider, transport) between success and failure groups.
• P value < 0.05 considered statistically significant.

Main Results:

• BNTI failure occurred in 11 of 36 attempts (31%), with a significantly higher failure rate (48%) in younger trauma patients at the scene of injury via rotor-wing transport compared to in-hospital settings (7%).
• All failed BNTIs were followed by OTI attempts, with an 18% failure rate.
• Both subsequent cricothyroidotomy attempts after failed OTI were successful.

Conclusions:

• Flight teams exhibit a low BNTI failure rate in hospitals (7%) but a substantially higher rate (48%) at injury scenes.
• Factors contributing to scene vs. in-hospital BNTI success rate disparities require further investigation.
• Subsequent OTI and cric procedures demonstrate high success rates following BNTI failure.