+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Prehospital intubation success rates among Israel Defense Forces providers: epidemiologic analysis and effect on doctrine



Prehospital intubation success rates among Israel Defense Forces providers: epidemiologic analysis and effect on doctrine



Journal of Trauma and Acute Care Surgery 75(2 Suppl 2): S178



Advanced airway management is composed of a set of vital yet potentially difficult skills for the prehospital provider, with widely different clinical guidelines. In the military setting, there are few data available to inform guideline development. We reevaluated our advanced airway protocol in light of our registry data to determine if there were a preferred maximum number of endotracheal intubation (ETI) attempts; our success with cricothyroidotomy (CRIC) as a backup procedure; and whether there were cases where advanced airway interventions should possibly be avoided. This is a descriptive, registry-based study conducted using records of the Israel Defense Forces Trauma Registry at the research section of the Trauma and Combat Medicine Branch, Surgeon General's Headquarters. We included all casualties for whom ETI was the initial advanced airway maneuver, and the number of ETI attempts was known. Descriptive statistics were used. Of 5,553 casualties in the Israel Defense Forces Trauma Registry, 406 (7.3%) met the inclusion criteria. Successful ETI was performed in 317 casualties (78%) after any number of ETI attempts; an additional 46 (11%) underwent CRIC, and 43 (11%) had advanced airway efforts discontinued. ETI was successful in 45%, 36%, and 31% of the first, second, and third attempts, respectively, with an average of 28% success over all subsequent attempts. CRIC was successful in 43 (93%) of 46 casualties in whom it was attempted. Of the 43 casualties in whom advanced airway efforts were discontinued, 29 (67%) survived to hospital discharge. After the first ETI attempt, success with subsequent attempts tended to fall, with minimal improvement in overall ETI success seen after the third attempt. Because CRIC exhibited excellent success as a backup airway modality, we advocate controlling the airway with CRIC if ETI efforts have failed after two or three attempts. We recommend that providers reevaluate whether definitive airway control is truly necessary before each attempt to control the airway.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 055120414

Download citation: RISBibTeXText

PMID: 23883905

DOI: 10.1097/ta.0b013e318299d650


Related references

Patient safety in pre-hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers. Critical Care 16(1): R24, 2012

A meta-analysis of prehospital airway control techniques part I: orotracheal and nasotracheal intubation success rates. Prehospital Emergency Care 14(3): 377-401, 2010

Tranexamic acid in the prehospital setting: Israel Defense Forces' initial experience. Injury 45(1): 66-70, 2014

Limiting out-of-hospital intubation in the Israel Defense Forces. Annals of Emergency Medicine 45(6): 677, 2005

Prehospital Trauma Experience of the Israel Defense Forces on the Syrian Border 2013-2017. Journal of Trauma and Acute Care Surgery 2019, 2019

Prehospital use of hemostatic dressings by the Israel Defense Forces Medical Corps: A case series of 122 patients. Journal of Trauma and Acute Care Surgery 79(4 Suppl 2): S204, 2015

Intubation success rates of prehospital rapid sequence induction. European Journal of Emergency Medicine 24(1): 77, 2017

A prospective epidemiologic study of shigellosis in the Israel Defense Forces: implications for the use of shigella vaccines. Israel Journal of Medical Sciences 23(7): 811-815, 1987

Success rates for initiation of intravenous therapy en route by prehospital care providers. American Journal of Emergency Medicine 8(4): 305-307, 1990

Intubation success rates of prehospital rapid sequence induction of anaesthesia by physicians versus paramedics. European Journal of Emergency Medicine 24(1): 76-77, 2017

Acute non b hepatitis in the israel defense forces comparison of some epidemiologic features before and after the usage of preexposure immune serum globulin prophylaxis. Hepatology 7(6): 1330-1332, 1987

Cuffed endotracheal tube use in paediatric prehospital intubation: challenging the doctrine?. Emergency Medicine Journal 24(1): 57-58, 2007

Comparison of prehospital insertion success rates and time to insertion between standard endotracheal intubation and a supraglottic airway. Resuscitation 82(12): 1529-1536, 2011

Multiple failed intubation attempts are associated with decreased success rates on the first rescue intubation in the emergency department: a retrospective analysis of multicentre observational data. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 23: 5, 2015

Institutional analysis and irregular warfare: Israel Defense Forces during the 33-Day War of 2006. Small Wars and Insurgencies 23(1): 32-55, 2012