Paramedic-performed rapid sequence intubation of patients with severe head injuries

San Diego County Emergency Medical Service, CA, USA.
Annals of Emergency Medicine (Impact Factor: 4.68). 09/2002; 40(2):159-67. DOI: 10.1067/mem.2002.126397
Source: PubMed


We evaluate the ability of paramedic rapid sequence intubation (RSI) to facilitate intubation of patients with severe head injuries in an urban out-of-hospital system.
Adult patients with head injuries were prospectively enrolled over a 1-year period by using the following inclusion criteria: Glasgow Coma Scale score of 3 to 8, transport time of greater than 10 minutes, and inability to intubate without RSI. Midazolam and succinylcholine were administered before laryngoscopy, and rocuronium was given after tube placement was confirmed by means of capnometry, syringe aspiration, and pulse oximetry. The Combitube was used as a salvage airway device. Outcome measures included intubation success rates, preintubation and postintubation oxygen saturation values, arrival arterial blood gas values, and total out-of-hospital times for patients intubated en route versus on scene.
Of 114 enrolled patients, 96 (84.2%) underwent successful endotracheal intubation, and 17 (14.9%) underwent Combitube intubation, with only 1 (0.9%) airway failure. There were no unrecognized esophageal intubations. On arrival at the trauma center, median oxygen saturation was 99%, mean arrival PO2 was 307 mm Hg, and mean arrival PCO2 was 35.8 mm Hg. Total out-of-hospital times were higher when RSI was performed on scene (26 versus 13 minutes).
Paramedics can use RSI protocols that include neuromuscular blocking and sedative agents to facilitate intubation of patients with head injuries.

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Available from: Peter Rosen, Feb 16, 2015
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    • "The need for alternative airway management devices especially in emergency care is evident. The value of paramedic performed prehospital intubation is undetermined [12], and even highly trained paramedical personnel have been shown to have difficulties with this procedure [13]. Maintaining adequate skills poses a further problem. "
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    • "intubation (RSI). Evidence exists that supports the ability of paramedics to perform RSI [1], and it is currently taught in the national paramedic curriculum [2]. Recently, these protocols have come under scrutiny on a large scale, and several points of concern have emerged. "
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