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Resuscitation. 2008 Nov;79(2):225-9. doi: 10.1016/j.resuscitation.2008.05.016. Epub 2008 Aug 6.

Should EMS-paramedics perform paediatric tracheal intubation in the field?

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1
Department of Anaesthesiology, Amphia Hospital, Postbus 90158, 4800 RK Breda, The Netherlands. bgerritse@amphia.nl

Abstract

OBJECTIVE:

To determine the incidence and success rate of out-of-hospital tracheal intubation (TI) and ventilation of children, taking account of the type of healthcare provider involved.

METHODS:

A prospective observational study to analyse a consecutive group of children for which a helicopter-transported medical team (HMT) was called. In all cases, the emergency medical service (EMS)-paramedics arrived at the scene first. Data regarding type of incident, physiological parameters, treatment, and survival until hospital discharge were collected and subsequently analysed.

RESULTS:

Of the 300 children examined and treated by the HMT on scene, 155 (52%) children required out-of-hospital tracheal intubation. Ninety-five children had an initial Glasgow Coma Scale (GCS) rating of 3-4: the EMS-paramedics performed bag-valve-mask-ventilation (BVMV) until arrival with subsequent TI carried out by the HMT (54 children, survival 63%) or the EMS-paramedics performed TI themselves (41 children, subsequent correction of tube/ventilation by HMT in 37% and survival rate 5%). Two hundred and five children had an initial GCS of 5-15, from which 60 children required TI (survival rate 67%) and 145 children required no TI (survival rate 100%).

CONCLUSION:

We do not recommend early TI by EMS-paramedics in children with a GCS of 3-4. The rate of complications of this procedure is unacceptably high. BVMV is the preferred choice for ventilation by paramedics, whenever possible. Out-of-hospital TI performed by HMT is safe and effective. The HMT has skills in advanced airway management not provided by the EMS.

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