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Checklists in pre-hospital advanced airway management
Cecilia Klingberg1,2, Daniel Kornhall1,3,4, Dan Gryth5,6,7
1Swedish Air Ambulance (SLA), Mora, Sweden.
Acta Anaesthesiologica Scandinavica
|August 23, 2019
Summary
Pre-intubation checklists (PICL) in pre-hospital care may reduce intubation attempts but do not significantly impact overall success rates or serious adverse events. Scene times were shorter without PICL.
Area of Science:
- Emergency Medicine
- Anesthesiology
- Pre-hospital Care
Background:
- Pre-intubation checklists (PICL) are standard safety tools in pre-hospital care.
- Their value among experienced providers remains unclear.
- This study investigates PICL benefits and drawbacks in the pre-hospital setting.
Purpose of the Study:
- To explore the benefits and disadvantages of pre-intubation checklists (PICL) in pre-hospital advanced airway management.
- To analyze the impact of PICL on intubation success rates, complications, and scene times.
Main Methods:
- Subgroup analysis of a prospective, observational, multicentre study in Nordic countries (May 2015 - Nov 2016).
- Included drug-assisted intubations performed by anaesthesiologists.
- Compared intubation success and complication rates with and without checklist use.
Main Results:
- 588 pre-hospital intubations analyzed; checklists used in 60.5%.
- Checklist use correlated with fewer intubation attempts and increased first/second attempt success.
- No significant difference in overall success rates (99.4% vs 99.1%); oesophageal misplacement higher without PICL (2.2% vs 0.3%).
- Scene times were significantly shorter without PICL (23.6 vs 27.5 minutes).
Conclusions:
- Checklist use in pre-hospital airway management correlated with fewer intubation attempts.
- No association found between PICL use and overall tracheal intubation success or serious adverse events.
- Pre-hospital intubation without checklists resulted in shorter scene times.
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