Association between location of prehospital intubation, complication rates and time intervals

It has been recommended that prehospital rapid sequence intubation (PH-RSI) be performed in locations that provide 360-degree access to the patient. We aimed to examine the success and complication rate of PH-RSI by location of intubation as well as the effect on scene time.

We conducted a single-centre, retrospective cohort study of patients with attempted PH-RSI over a 96-month period. Locations compared were intubation within the road ambulance, outside the vehicle on a stretcher, on the ground and in other locations. The primary outcome was the occurrence of major intubation complications by location. Secondary outcomes were first-pass success, time to intubation from patient contact and total scene time. Modified Poisson with robust SE variance and quantile regressions was used to adjust for confounding variables.

Of 413 patients, major intubation complications occurred in 60 (14.5%, 95% CI 11.3% to 18.3%) patients. Patients intubated on the ground were twice as likely to have complications than patients intubated on a stretcher outside the vehicle (p=0.023) in the unadjusted analysis. First-pass success intubations occurred in 400 (96.9%, 95% CI 94.7% to 98.3%). Adjusted time from contact to intubation was not different (p=0.864) but total scene time was significantly shorter for patients intubated inside an ambulance compared with outside on a stretcher (median difference -4.0 min, 95% CI -6.5 to 1.5; p=0.002).

Intubating selected patients within an ambulance had similar complication rates to intubation on a stretcher outside the vehicle but was associated with a small reduction in on-scene time.