An analysis of advanced prehospital airway management

Considerable controversy persists regarding the optimal means and indications for airway management, the utility of paralytic agents to facilitate intubation, and the indications for advanced airway access techniques in the prehospital setting. To describe the use of intubation and advanced airway management in a system with extensive experience with both the use of paralytic agents and surgical airway techniques, a retrospective review was conducted of all prehospital airway procedures from January 1997 through November 1999. Data collected included demographics, airway management techniques, use of paralytic agents, and immediate outcome. The results showed there were 2700 patients intubated out of 50,118 patient encounters (5.4%). The indications for intubation included medical emergency in 82% of patients and traumatic injury in 18%. Fifty percent of patients were intubated with the use of succinylcholine. The overall oral intubation success rate was 98.4% and definitive airway access was achieved in all but 12 patients (0.6%), with 30 patients receiving surgical airway access (1%). The successful intubation rate for patients receiving paralytic agents was 97.8%. Previously published rates of prehospital surgical airway access range from 3.8 to 14.9% of patients. In this study, only 1.1% of patients required a surgical airway. We attribute this low rate to the use of paralytic agents. The availability of paralytic agents also allows expansion of the indications for prehospital airway control.