Research has identified the most effective way to insert breathing tubes in air ambulance patients on the way to the hospital. The finding, that a combination of sedative and paralytic drugs increased the chance of success by almost fourfold, may also apply to other types of pre-hospital care.
"Having solid evidence for what method is most effective allows us to offer the best care possible to patients in these life-or-death situations," said William Bozeman, M.D., lead author, from Wake Forest University Baptist Medical Center.
Results from the study are reported in the current issue of Prehospital Emergency Care. It compared the combination of sedative and paralytic drugs (to relax the airway and the patient), with the use of a sedative alone.
Previous studies had compared drug protocols, but looked only at whether insertion of the breathing tube was successful. The current study went a step further and measured and recorded the condition of the airway. Even if the insertion, or intubation, is successful, there can be damage to the airway or other complications that can result in disability or death.
For each patient, the crew recorded the airway conditions, such as whether the vocal cords were visible, whether the patient was relaxed and whether the intubation was successful. The study involved 49 patients who were transported over a year's time by two helicopters in the same system.
Each helicoptor's medical crew consisted of a nurse and paramedic with a mean of 18 years of medical experience and seven years of flight experience. For six months, one helicoptor's patients received the sedative alone and the other helicoptor's patients got the combination of a sedative and a paralytic drug. For the next six months, the protocols were switched. Before the study was conducted, the air ambulance service had used both protocols.
Most (90 percent) of the patients were being transported by air ambulance after an automobile accident or other trauma.
"We found that using the sedative alone resulted in lower intubation success and a more difficult intubation," said Bozeman, who is an emergency medicine and pre-hospital emergency medical services (EMS) specialist.
The likelihood of successful intubaton was 3.7 times higher with the combination of medications, which is called rapid-sequence intubation. The authors said that the findings may apply to other types of pre-hospital care, including ground ambulances, depending on the experience of the crews.
"EMS medical directors must carefully match the choice of intubation medications to the training and skill levels of the system's providers," said Bozeman. "In some systems, using basic oxygen and techniques to keep the airway open -- and not attempting intubation -- is the safest option for patients. In other systems with highly skilled and experienced providers who work under close medical oversight, rapid-sequence intubation may be the best choice."
The research involved the air ambulance service of the University of Florida and the Trauma One Flight Services of Shands Jacksonville Hospital.
Co-researchers were Douglas M. Kleiner, Ph.D., and Vicki Huggett, R.N., with the University of Florida. Bozeman was a faculty member at the University of Florida at the time the research was conducted.
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