Paramedic intubation: patient position might matter.

Area of Science:

• Emergency Medicine
• Prehospital Care
• Airway Management

Background:

• Paramedics frequently perform endotracheal intubation in challenging prehospital environments.
• Patient positioning is a variable that may influence intubation success rates in emergency settings.

Purpose of the Study:

• To evaluate the impact of patient position on prehospital endotracheal intubation success rates.
• To compare intubation success on cadavers positioned on the floor, a low stretcher (simulating an ambulance), and an elevated stretcher.

Main Methods:

• A cadaver model was used with 84 paramedics performing intubations.
• Participants attempted endotracheal intubation in three positions: floor, low stretcher, and elevated stretcher.
• Intubation success was verified by direct visualization, with a maximum of three attempts per cadaver.

Main Results:

• First-attempt success rates were 77.4% (floor), 74.7% (low stretcher), and 86.9% (elevated stretcher).
• Cumulative first- and second-attempt success rates were 89.3% (floor), 94.0% (low stretcher), and 96.4% (elevated stretcher).
• First-attempt success was significantly higher in the elevated stretcher position compared to the low stretcher position (OR = 2.25).

Conclusions:

• Endotracheal intubation success rates were highest when the cadaver was positioned on an elevated stretcher.
• Paramedics should consider patient positioning as a critical factor to optimize prehospital intubation success.