PREFLIGHT VERSUS EN-ROUTE SUCCESS AND COMPLICATIONS OF RAPID-SEQUENCEINTUBATION IN AN AIR MEDICAL-SERVICE

Background: Maintenance of an airway in the air medically transported patient is of paramount importance. The purpose of this study is to co mpare preflight versus en route rapid sequence intubation (RSI)-assist ed intubations and to determine the value of air medical use of RSI, M ethods: This study is a 31-month retrospective review of all patients intubated and transported by a large city air medical service. Subgrou p analysis was based on whether patients were transported from a hospi tal or a scene and whether they were intubated preflight or en route, Information on age, Glasgow Coma Scale score, type of scene, ground ti me, and previous attempts at intubation was recorded. Complications in cluded failures, multiple attempts at intubation, arrhythmias, and nee d for repeated paralytic agents. Comparisons were made using a confide nce interval analysis. An alpha of 0.05 was considered significant; Bo nferroni correction was used for multiple comparisons. Results: Three hundred twenty-five patients were intubated and transported by Lifefli ght during the study period. Two hundred eighty-eight patients were in tubated using RSI (89%). The success rate was 97%. Preflight intubatio ns were performed on 100 hospital calls and 86 scene calls. En route i ntubations were performed on 40 hospital cases and 62 scene calls. Pat ients who underwent preflight intubations were significantly younger t han those who underwent en route intubations for both the hospital gro up (34 +/- 11 vs, 44 +/- 24 years, p < 0.05) and the scene group (27 /- 13 vs, 32 +/- 16 years,p < 0.05), Otherwise, the demographic charac teristics of the four groups were similar. Trauma accounted for GO to 70% of hospital transfers and almost 95 to 100% of scene calls. Compar ed with preflight intubations, there was a significant decrease in gro und time for hospital patients who were intubated en route (26 +/- 10 vs. 34 +/- 11 minutes, p < 0.05) and for scene patients who were intub ated en route (11 +/- 8 vs, 18 +/- 9 minutes, p < 0.05), There were no significant differences between the groups for number of failures (9 of 288), arrhythmias (18 of 288), or necessity for repeated paralysis (8 of 288), Multiple intubation attempts were performed in more scene preflight patients (30 of 86, 35%) than scene en route patients (16 of 62, 26%), but this did not reach statistical significance. Even for p atients having previous attempts at intubation, the success rate using RSI was 93% (62 of 67). Conclusion: Air medical intubations, both pre flight and en route, for both scene calls and interhospital transports , can be done with a very high success rate. Rapid sequence intubation may improve the success rate. Far scene! calls, there was a significa nt decrease in ground time, and there was a trend toward fewer multipl e intubation attempts when the patient was intubated en route instead of preflight.