ENDOTRACHEAL INTUBATION BY PARAMEDICS DURING IN-HOSPITAL CPR

Study objective: To examine whether well-trained paramedics can perfor m emergent, successful, uncomplicated, endotracheal intubations during in-hospital cardiopulmonary resuscitation (CPR). Design: Retrospectiv e review of medical records of inpatients undergoing emergent, endotra cheal intubations during in-hospital, CPR over 8 months, with comparis on of the performance of the paramedics against that of other hospital -based personnel. Setting: A 437-bed Midwestern community teaching hos pital. Patients: Adult in-patients in general medical/surgical wards. Main outcome measures: The rapidity of response of paramedics and othe r medical personnel to a cardiorespiratory arrest (code 4) announcemen t, and reported difficulties, success rate, rapidity, and complication s of endotracheal intubation. Results: In the 47 cardiorespiratory arr ests requiring intubation that we analyzed, the median response times (with values in parentheses representing interquartile range [IQR]) fo r paramedics, nurse anesthetists (CR-NAs), anesthesiologists, and othe r physicians respectively, were 2.00 (4.25), 4.00 (2.0), 4.00 (15.0), and 7.00 (8.0) min, requiring a median of 1.0 attempt for all groups ( mean values, 1.4, 1.125, 1.0, and 1.4 respectively) to place an endotr acheal tube. The paramedics were successful in 13 of 15 instances. Med ian times (seconds) required for intubation by various groups (same or der as response times, with IQR given in parentheses) were 60 (30), 15 0 (270), 45 (30), and 60 (30). Difficulties were reported by all group s, including patients' resistance to intubation, airway obstruction by extraneous material, and difficulty in visualizing the glottis. Repor ted complications (4%) were confined to groups other than the paramedi cs. Conclusions: Paramedics can successfully, and without undue diffic ulty or complications, place endotracheal tubes during in-hospital CPR . Appropriately trained paramedics may be incorporated into hospital-b ased CPR teams in two contexts: (1) to provide an acceptable, long-ter m solution to the scarcity of personnel highly skilled in endotracheal tube placement during in-hospital CPR, and (2) to fulfill the need fo r hospitals to have on-site, qualified professionals to perform emerge nt endotracheal intubation during CPR. In the latter situation, person nel skilled in airway management could supplement the paramedics on de mand. Further investigation in this area could be fruitful in view of the small sample size covered in this study.