Paramedic success rate for blind nasotracheal intubation is improved with the use of an endotracheal tube with directional tip control

Study objectives: Blind nasotracheal intubation (BNTI) is used to secure th e airway in patients who are spontaneously breathing. The success rate for BNTI is often lower than for orotracheal intubation. We conducted this stud y to determine whether the use of an endotracheal tube (ETT) capable of dir ectional tip control can improve the BNTI success rate. Methods: This prospective, experimental study was conducted by a state emer gency medical services agency during 1997, 1998, and 1999. Consecutive pati ents undergoing attempted BNTI or orotracheal intubation were included. Fiv e paramedic units were trained to use an Err with triggeractivated distal t ip directional control for BNTIs (intervention group). Ten units used conve ntional Errs for BNTIs and served as concurrent controls (control group). S ubjects in the 2 groups were enrolled concurrently with nonrandomized alloc ation based on the agency providing service. An intubation attempt was defi ned by tube passage, and success was defined as confirmed endotracheal plac ement. Results: A total of 219 BNTIs were studied (141 in the control group and 78 in the intervention group). BNTI was successful in 82 (58%) of 141 cases u sing conventional Errs, and in 56 (72%) of 78 cases using directional tip c ontrol (P=.04). The overall success rate was 63%. Conclusion: Use of Errs with distal directional control is associated with a higher success rate for BNTI than conventional Errs. Use of Errs with dir ectional tip control significantly improves the success rates for BNTIs.