NEUROMUSCULAR BLOCKADE-ASSISTED ORAL INTUBATION VERSUS NASOTRACHEAL INTUBATION IN THE PREHOSPITAL CARE OF INJURED PATIENTS

Study objective: To compare nasotracheal intubation (NTI) to neuromusc ular blockade-assisted oral intubation (NMB-assisted oral intubation) in the prehospital care of injured patients. Design: Prospective, rand omized study conducted over 21 months. Setting: A university hospital- sponsored helicopter service. Participants: Consecutive adult (more th an 12 years old) injured patients at the accident scene with an initia l Glasgow Coma Scale of 8 or less in whom the airway was not managed i mmediately by unrelaxed oral intubation or cricothyrotomy. Subjects we re randomized by 24-hour time blocks into NTI or NMB-assisted oral int ubation treatment groups. Forty-four were entered into the NTI group ( 39 randomized, two crossed over to NMB-assisted oral intubation), and 33 were entered into the NMB-assisted oral intubation group (38 random ized, seven crossed over to NTI). Interventions: NMB-assisted oral int ubation (succinylcholine 1.5 mg/kg IV) or NTI was carried out accordin g to standard protocols. Results: The success rate for NTI was 79.5% ( 35 of 44) and was similar to that of NMB-assisted oral intubation, 75. 8% (25 of 33; chi2 = .16; P = .69). There were no significant differen ces between the NTI and the NMB-assisted oral intubation groups with r egard to sex, age, outcome, and Glasgow Coma Scale. For those patients in whom the initial technique was successful, NTI was significantly q uicker than NMB-assisted oral intubation (mean time of NTI, 2.9 minute s; mean time of NMB-assisted oral intubation, 5.9 minutes; Mann-Whitne y U, 168.0; P<.01). Conclusion: In the prehospital management of sever ely injured patients, there is no significant difference between NMB-a ssisted oral intubation and NTI in the rate at which endotracheal intu bation is achieved. However, practitioners may prefer NTI because it r equires significantly less time to perform than NMB-assisted oral intu bation.