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Inclined position is associated with improved first pass success and laryngoscopic view in prehospital endotracheal intubations.
Am J Emerg Med 2019; 37(5):937-941AJ

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.

Authors+Show Affiliations

Department of Emergency Medicine, University of Washington, Seattle, WA, USA. Electronic address: dlmurphy@uw.edu.Department of Medicine, University of Washington, Seattle, WA, USA; King County Emergency Medical Services, Seattle, WA, USA.Department of Emergency Medicine, University of Washington, Seattle, WA, USA; Seattle Fire Department, Seattle, WA, USA.Department of Emergency Medicine, University of Washington, Seattle, WA, USA; Seattle Fire Department, Seattle, WA, USA.King County Emergency Medical Services, Seattle, WA, USA.Seattle Fire Department, Seattle, WA, USA.Department of Emergency Medicine, University of Washington, Seattle, WA, USA; Seattle Fire Department, Seattle, WA, USA.Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.Department of Emergency Medicine, University of Washington, Seattle, WA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30826211

Citation

Murphy, David L., et al. "Inclined Position Is Associated With Improved First Pass Success and Laryngoscopic View in Prehospital Endotracheal Intubations." The American Journal of Emergency Medicine, vol. 37, no. 5, 2019, pp. 937-941.
Murphy DL, Rea TD, McCoy AM, et al. Inclined position is associated with improved first pass success and laryngoscopic view in prehospital endotracheal intubations. Am J Emerg Med. 2019;37(5):937-941.
Murphy, D. L., Rea, T. D., McCoy, A. M., Sayre, M. R., Fahrenbruch, C. E., Yin, L., ... Mitchell, S. H. (2019). Inclined position is associated with improved first pass success and laryngoscopic view in prehospital endotracheal intubations. The American Journal of Emergency Medicine, 37(5), pp. 937-941. doi:10.1016/j.ajem.2019.02.038.
Murphy DL, et al. Inclined Position Is Associated With Improved First Pass Success and Laryngoscopic View in Prehospital Endotracheal Intubations. Am J Emerg Med. 2019;37(5):937-941. PubMed PMID: 30826211.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inclined position is associated with improved first pass success and laryngoscopic view in prehospital endotracheal intubations. AU - Murphy,David L, AU - Rea,Thomas D, AU - McCoy,Andrew M, AU - Sayre,Michael R, AU - Fahrenbruch,Carol E, AU - Yin,Lihua, AU - Tonelli,Benjamin A, AU - Joffe,Aaron M, AU - Mitchell,Steven H, Y1 - 2019/02/25/ PY - 2019/01/12/received PY - 2019/02/23/revised PY - 2019/02/24/accepted PY - 2019/3/4/pubmed PY - 2019/3/4/medline PY - 2019/3/4/entrez KW - Emergency medical services KW - Endotracheal intubation KW - First pass success KW - Patient positioning KW - Rapid sequence intubation SP - 937 EP - 941 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 37 IS - 5 N2 - 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. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/30826211/Inclined_position_is_associated_with_improved_first_pass_success_and_laryngoscopic_view_in_prehospital_endotracheal_intubations_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(19)30125-1 DB - PRIME DP - Unbound Medicine ER -