Out-of-hospital Airway Management in the United States

The below abstract is from Resuscitation, Volume 82, available at Science Direct. It provides a detailed examination of out-of-hospital airway management, success rates, and complicating factors. The crux of the article for tactical medics is the need to maintain skills through training, because the low ratio of calls to the need for invasive airway interventions, even in the EMS sector, suggests that real-world practice is not sufficient. It points to the low success rate of reported advanced interventions as proof, claiming that the rate might be high due to one not wanting to report failures. Finally, in addition to skill fade, failure is also attributed to vomit, blood, and mucus, all hindrances faced in the tactical environment, as a factors leading to failed advanced airway management. In the end, tactical medics may not manage enough advanced airways to maintain their skills, thus they need to find appropriate training models if live-tissue training is not available. Unfortunately, this article does not provide many alternatives.

A b s t r a c t
Objective: Prior studies describe airway management by single EMS agencies, regions or states.We sought
to characterize out-of-hospital airway management interventions, outcomes and complications across
the United States.

Methods: Using the 2008 National Emergency Medical Services Information System (NEMSIS) Public-Release Data Set containing data from 16 states, we identified patients receiving advanced airway management, including endotracheal intubation (ETI), alternate airways (Combitube, Laryngeal Mask Airway (LMA), King LT, Esophageal-Obturator Airway (EOA)), and cricothyroidotomy (needle and open). We examined airway management success and complications in the full cohort and in key subsets (cardiacarrest, non-arrest medical, non-arrest injury, children <10 and 10–19 years, rapid-sequence intubation (RSI), population setting and US census region). We analyzed the data using descriptive statistics.

Results:Among4,383,768EMSactivations, there were 10,356 ETI, 2246 alternate airways, and 88 cricothyroidotomies.
ETI success rates were: overall 6482/8418 (77.0%; 95% CI: 76.1–77.9%), cardiac arrest 3494/4482 (78.0%), non-arrest medical 616/846 (72.8%), non-arrest injury 417/505 (82.6%), children<10 years 295/397 (74.3%), children 10–19 years 228/289 (78.9%), adult 5829/7552 (77.2%), and rapidsequence
intubation 289/355 (81.4%). ETI success was success was lowest in the South US census region. Alternate airway success was 1564/1794 (87.2%). Major complications included: bleeding 84 (7.0 per 1000 interventions), vomiting 80 (6.7 per 1000) and esophageal intubation 12 (1.0 per 1000).

Conclusions: In this study characterizing out-of-hospital airway management across the United States, we observed low out-of-hospital ETI success rates. These data may guide national efforts to improve the quality of out-of-hospital airway management.