Abstract
Purpose
In hospital-based studies, patients intubated by physicians while in an inclined position
compared to supine position had a higher rate of first pass success and lower rate
of peri-intubation complications. We evaluated the impact of patient positioning on
prehospital endotracheal intubation in an EMS system with rapid sequence induction
capability. We hypothesized that patients in the inclined position would have a higher
first-pass success rate.
Methods
Prehospital endotracheal intubation cases performed by paramedics between 2012 and
2017 were prospectively collected in airway registries maintained by a metropolitan
EMS system. We included all adult (age ≥ 18 years) non-traumatic, non-arrest patients
who received any attempt at intubation. Patients were categorized according to initial
positioning: supine or inclined. The primary outcome measure was first pass success
with secondary outcomes of laryngoscopic view and challenges to intubation.
Results
Of the 13,353 patients with endotracheal intubation attempted by paramedics during
the study period, 4879 were included for analysis. Of these, 1924 (39.4%) were intubated
in the inclined position. First pass success was 86.3% among the inclined group versus
82.5% for the supine group (difference 3.8%, 95% CI: 1.5%–6.1%). First attempt laryngeal
grade I view was 62.9% in the inclined group versus 57.1% for the supine group (difference
5.8%, 2.0–9.6). Challenges to intubation were more frequent in the supine group (42.3%
versus 38.8%, difference 3.5%, 0.6–6.3).
Conclusion
Inclined positioning was associated with a better grade view and higher rate of first
pass success. The technique should be considered as a viable approach for prehospital
airway management.
Keywords
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Article Info
Publication History
Published online: February 25, 2019
Accepted:
February 24,
2019
Received in revised form:
February 23,
2019
Received:
January 12,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
