Prehospital intubation – good or bad? We like to think we’re doing good for the patient. Most studies reviewing prehospital intubations report excellent numbers for highly trained services, like HEMS with a doctor as part of the team. But it’s hard to find good studies on an emergency out-of-hospital procedure like this, especially trying to work out if the intervention is more than just a technical success – if it’s actually helping the patient. A new multi-service study is trying to alleviate this. Enter AIRway study using an uniform PrehOspital data Reporting Template – the AIRPORT study.
It’s a study coordinated by the Norwegian Air Ambulance Foundation and Haukeland University Hospital, Bergen, Norway, as a collaborative effort by HEMS services in London, Sydney, Hungary, Finland and Norway. Apart from the awkward force fitting of their acronym into the title, the study will be interesting to follow.
“Advanced airway management and ventilatory control is generally regarded as vital in the management of seriously ill or injured patients, and can be critical interventions in patients with out-of-hospital emergencies. However, interventions like endotracheal intubation suffer from lack of clear evidence of a beneficial effect. Despite the publication of numerous airway management studies, inconsistent and imprecise reporting of data across heterogenous patient populations and EMS systems persists. The questions of how, and by whom, pre-hospital advanced airway management should be performed remains disputed.”
“In this multicentre study, we have enlisted key international HEMS from 5 countries (UK, Australia, Hungary, Finland and Norway), and will collect data according to the Utstein style template over a 12 month study period starting January 1, 2012.”
The Airport study was born out of this article: Revisiting the value of pre-hospital tracheal intubation: an all time systematic literature review extracting the Utstein airway core variables Lossius et al, Crit Care 2011. Finding conflicting articles on the outcome of prehospital intubation, and addressing The need for standardized data reporting for prehospital airway management.
The decision to intubate is not one to be taken lightly. But in my opinion it is still a good indication to intubate a patient that would be intubated on arrival to the emergency department. Providing meaningful interventions as early and safely as possible will always make sense to me. These decisions need to be made on-scene by an experienced clinician. Hopefully, the AIRPORT study can help aid decisions around airway management.
Read the full outline of the AIRPORT study on www.ClinicalTrials.gov. Data collection should finish by the end of 2012 and data crunching will begin.
In the meantime, have a look at this presentation by David Lockey: “Prehospital intubation – why all the controversy?”, a good primer on prehospital intubations and its controversies. Also some references to relevant studies. David Lockey is an anaesthetist and intensivist, UK’s first honorary professor of trauma and pre-hospital emergency medicine and a long time consultant for London HEMS.
The image above of a NSW Air Ambulance team intubating was blatantly ripped from the excellent emergency medicine blog resus.me without prior permission.