Prehospital advanced airway management in the Nordic countries

• Main Author: Gellerfors, Mikael
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: Inst för klinisk forskning och utbildning, Södersjukhuset / Dept of Clinical Science and Education, Södersjukhuset 2018
• Subjects: Subarctic
• Online Access: http://hdl.handle.net/10616/46292

Tracheal intubation (TI) is often the preferred technique to secure the airway of an unconscious patient in the prehospital setting. Prehospital TI is associated with several challenges, including limited assistance, few airway rescue devices and environmental difficulties. An example of the latter is the occasional need for TI inside the cabin of an ambulance helicopter. The Nordic countries consist of both rural and urban areas with typically cold subarctic climate. The region is characterized by almost exclusive use of airway experts, mainly anaesthetists, for prehospital TI. The overall aim was to investigate prehospital advanced airway management in Nordic countries with regard to success rates, times, providers and techniques. Study I: A retrospective observational study of all patients intubated out-of-hospital with the device Airtraq® in Stockholm 2008-2012. A total number of 2453 patients were intubated during the study period and Airtraq® was used in 28 (1.1%) cases. Sixty-eight percent (19/28) of the Airtraq® intubation attempts were successful. When used due to an anticipated or unexpected difficult airway, the success rate was 61% (14/23). Study II: An experimental prospective randomized crossover manikin study on anaesthetist TI was conducted in a military helicopter cabin in daylight or darkness with night vision goggles (NVG) or in a daylight emergency department (ED) setting. The TI success rate was 100% in all scenarios. The in-cabin helicopter TI time was shorter in daylight vs. darkness with NVG (16.5 s vs. 30.0 s; p=0.03). There was no difference in TI time between the helicopter cabin daylight and ED setting (16.5 vs. 16.8 s; p=0.91). There was no difference in either glottic visualization (CL 2.0 vs. 1.8; p=0.72) or perceived intubation difficulty (VAS 3.0 vs. 2.8; p=0.24) between the daylight helicopter and ED scenarios. Study III: A prospective observational study of advanced airway management by twelve second-tier prehospital critical care teams in the Nordic countries was conducted ...