Randomized Trials of Prehospital Endotracheal Intubation in Cardiac Arrest

Out-of-hospital cardiac arrest (OHCA) is a major public health problem affecting over 300,000 persons annually in the United States.1 Endotracheal intubation (ETI) is one of most common procedures performed by paramedics during resuscitation. However, numerous factors have motivated new strategies for OHCA airway management, including the use of supraglottic airway (SGA) devices. Scientists in the U.S. and the United Kingdom are preparing to carry out largescale randomized controlled trials (RCT) to compare the effectiveness of ETI and SGA on OHCA outcomes. In this article we provide an overview of the rationale for and design of these landmark research studies. PITFALLS OF PREHOSPITAL INTUBATION Although a mainstay of U.S. paramedic practice for over 30 years, many research studies have highlighted the perils and pitfalls of prehospital ETI. ET tubes are frequently misplaced2 or dislodged, and multiple and failed intubation attempts are common.3–5 There’s also growing awareness that intubation may interfere with other key resuscitation tasks. Inadvertent hyperventilation is common after intubation during OHCA resuscitation, resulting in increased intrathoracic pressure and reduced CPR coronary blood flow.6,7Intubation efforts have also been shown to cause frequent and prolonged CPR interruptions.8 Paramedic training in intubation in the U.S. is also suboptimal. The operating room is an ideal controlled setting for learning ETI, but paramedic students have limit...
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Research Special Topics Patient Care Source Type: news