Difficult Airway in the Prehospital Emergency Setting
Portuguese Reality
DOI:
https://doi.org/10.25751/rspa.18115Keywords:
Airway Management; Airway Obstruction; Algorithms; Emergency Medical Services; Intubation, IntratrachealAbstract
Introduction: It is estimated that advanced airway management is particularly difficult in prehospital emergency context. Due to the lack of Portuguese data, it was intended to characterize the incidence of
difficult and failed intubation in this environment, understand the expertise of physicians in this area and describe the most used and potentially useful adjuvant materials.
Methods: An online and anonymous survey was conducted for the medical operators of the 44 Medical Emergency and Resuscitation Vehicles (VMER).
Results: We obtained 120 valid answers. There were 1878 tracheal intubations in one year, 378 difficult (20%) and 78 failed (4%). It was found that non-anesthesiologists had a higher rate of failing intubation compared to anesthesiologists (p = 0.006) and those who performed intubation less than once a week compared to
those who perform intubation more than once a week (p = 0.003). The stylet was the most used equipment in difficult airway and the videolaryngoscope was referred as the most useful. The training of physicians was considered to be insufficient according to the majority of respondents.
Discussion: There is a need to develop algorithms and regular training programs for prehospital doctors. The videolaryngoscope should be considered in this environment. We present a proposed algorithm for
airway management in prehospital emergency context.
Conclusion: Management of the airway is a competence of the prehospital emergency professionals, being central to wage its effective training. The existence of difficult airway protocols and new adjuvant materials may facilitate the approach of these cases.
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References
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