Improved Survival Rates for Out of Hosp Intubation.

[tniuqs]

Out-of-Hospital Endotracheal Intubation Experience and Patient Outcomes

Presented at the National Association of EMS Physicians annual meeting, January 2009, Jacksonville, FL.

Henry E. Wang, MD, MSa, G.K. Balasubramani, PhDb, Lawrence J. Cook, PhDe, Judith R. Lave, PhDc, Donald M. Yealy, MDd

Received 7 April 2009; received in revised form 5 October 2009 and 1 December 2009; accepted 11 December 2009. published online 08 February 2010.

Corrected Proof

Study objective

Previous studies suggest improved patient outcomes for providers who perform high volumes of complex medical procedures. Out-of-hospital tracheal intubation is a difficult procedure. We seek to determine the association between rescuer procedural experience and patient survival after out-of-hospital tracheal intubation.

Methods

We analyzed probabilistically linked Pennsylvania statewide emergency medicine services, hospital discharge, and death data of patients receiving out-of-hospital tracheal intubation. We defined tracheal intubation experience as cumulative tracheal intubation during 2000 to 2005; low=1 to 10 tracheal intubations, medium=11 to 25 tracheal intubations, high=26 to 50 tracheal intubations, and very high=greater than 50 tracheal intubations. We identified survival on hospital discharge of patients intubated during 2003 to 2005. Using generalized estimating equations, we evaluated the association between patient survival and out-of-hospital rescuer cumulative tracheal intubation experience, adjusted for clinical covariates.

Results

During 2003 to 2005, 4,846 rescuers performed tracheal intubation. These individuals performed tracheal intubation on 33,117 patients during 2003 to 2005 and 62,586 patients during 2000 to 2005. Among 21,753 cardiac arrests, adjusted odds of survival was higher for patients intubated by rescuers with very high tracheal intubation experience; adjusted odds ratio (OR) versus low tracheal intubation experience: very high 1.48 (95% confidence interval [CI] 1.15 to 1.89), high 1.13 (95% CI 0.98 to 1.31), and medium 1.02 (95% CI 0.91 to 1.15). Among 8,162 medical nonarrests, adjusted odds of survival were higher for patients intubated by rescuers with high and very high tracheal intubation experience; adjusted OR versus low tracheal intubation experience: very high 1.55 (95% CI 1.08 to 2.22), high 1.29 (95% CI 1.04 to 1.59), and medium 1.16 (95% CI 0.97 to 1.38). Among 3,202 trauma nonarrests, survival was not associated with rescuer tracheal intubation experience; adjusted OR versus low tracheal intubation experience: very high 1.84 (95% CI 0.89 to 3.81), high 1.25 (95% CI 0.85 to 1.85), and medium 0.92 (95% CI 0.67 to 1.26).

Conclusion

Rescuer procedural experience is associated with improved patient survival after out-of-hospital tracheal intubation of cardiac arrest and medical nonarrest patients. Rescuer procedural experience is not associated with patient survival after out-of-hospital tracheal intubation of trauma nonarrest patients.

[rock_shoes]

So what are you saying Squint? Patients requiring intubation have better survival odds when the paramedic performing the intubation is experienced? Say it isn't so.

Kind of a "don't throw the baby out with the bathwater" situation isn't it. If you perform a procedure poorly don't blame the procedure. Actively seek ways to improve performance.

[tniuqs]

So what are you saying Squint? Patients requiring intubation have better survival odds when the paramedic performing the intubation is experienced? Say it isn't so.

Kind of a "don't throw the baby out with the bathwater" situation isn't it. If you perform a procedure poorly don't blame the procedure. Actively seek ways to improve performance.

What I am saying that this is a realistic study and a positive, athis fter Wang et all jumped on the "airway adjunct" bandwagon and poorly peer reviewed studies did overall negatively affect our profession.

cheers

Just pleased to see that a new direction should be promoted instead of emptying the bathwater, get those Paramedics into ORs or ERs to practice their skills and improve success's. Its almost the same as Olympic athletes, practice and training ... who would a thought EH ?

Edited February 22, 2010 by tniuqs

[rock_shoes]

Just pleased to see that a new direction should be promoted instead of emptying the bathwater, get those Paramedics into ORs or ERs to practice their skills and improve success's. Its almost the same as Olympic athletes, practice and training ... who would a thought EH ?

Exactly. Just today I was watching a podcast from McGill University discussing the use of high-fidelity simulations as a training adjunct for physicians. The presenter made some strong arguments that are pretty difficult to deny. One of the biggest benefits I was able to discern is the change in case review that is able to take place. It allows for a much more complete and critical review minus risk to patients and minus any confidentiality concerns.