Abstract
Background
Prehospital airway management remains crucial with regards to the quality and safety of Emergency Medical Service (EMS) systems worldwide. In 2007, the benchmark study by Timmermann et al. hit the German EMS community hard by revealing a significant rate of undetected oesophageal intubations leading to an often-fatal outcome. In the meantime, much attention has been given to guideline development and training. This study evaluates the incidence and special circumstances of tube misplacement as an adverse peri-intubation event from a Helicopter Emergency Medical Services perspective.
Methods
Retrospective analysis of a German air rescue service database from January 1, 2012 to December 31, 2020. All registered patients were included into the primary analysis. Results were analyzed using SPSS 27.0.1.0..
Results
Out of 227459 emergency medical responses, a total of 18087 (8.0%) involved invasive airway management. In 8141 (45.0%) of these, airway management devices had been used by ground-based EMS staff with an intubation rate of 96.6% (n = 7861) and use of alternative airways in 3.2% (n = 285). Overall endotracheal intubation success was 94.7% while adverse events in the form of tube misplacement were present in 5.3% with a 1.2% rate of undetected oesophageal intubation. Airway management failure occurred more often after intubation carried out by paramedics (10.4%). In view of special circumstances, those errors occurred more often in the presence of trauma or cardiopulmonary resuscitation with a rate of 5.6% and 6.4%, respectively. Difficult airway with a Cormack 4 status was present in 2.1% (n = 213) of HEMS cases accompanied by three or more intubation attempts in 5.2% (n = 11).
Conclusions
Prehospital airway management success has improved significantly over the last years. However, adverse peri-intubation events such as undetected oesophageal intubation remain a persistent threat with regards to patient safety.