Introduction
Data variable name | Data variable categories or values | Definition of data variable |
---|---|---|
System variables
| ||
Highest level of EMS provider on scene | 1 = EMS non-P 2 = EMS-P 3 = Nurse 4 = Physician 5 = Unknown | Highest level of EMS provider on scene, excluding any non-EMS personnel (e.g., bystanders, family etc) |
Airway device available on scene | 1 = BMV 2 = Extraglottic device 3 = ETT 4 = Surgical airway 5 = None 6 = Unknown | Airway devices available on scene and provider on scene who knows how to use it |
Drugs for airway management available on scene | 1 = Sedatives 2 = NMBA 3 = Analgetics/opioids 4 = Local/topic anaesthetic 5 = None | Drugs used for airway management, available on scene and someone competent to administer |
Main type of transportation | 1 = Ground ambulance 2 = Helicopter ambulance 3 = Fixed-wing ambulance 4 = Private or public vehicle 5 = Walk-in 6 = Police 7 = Other 8 = Not transported 9 = Unknown | Main type of transportation vehicle (if multiple chose vehicle used for the majority of the transportation phase) |
Response time | Minutes | Time from Emergency Medical Communication Centre operator initiates transmission of dispatch message to first resource/unit time of arrival on scene of first unit as reported by first unit |
Patient variables
| ||
Co-morbidity | 1 = No (ASA-PS = 1) 2 = Yes (ASA-PS = 2-6) 3 = Unknown | ASA-PS definition 1 = A normal healthy patient 2 = A patient with mild systemic disease 3 = A patient with severe systemic disease 4 = A patient with severe systemic disease that is a constant threat to life 5 = A moribund patient who is not expected to survive without the operation 6 = A declared brain-dead patient whose organs are being removed for donor purposes |
Age | Years or months | Years, if patient <2 years then months |
Gender | 1 = Female 2 = Male 3 = Unknown | Patients gender |
Patient category | 1 = Blunt trauma (incl burns) 2 = Penetrating trauma 3 = Non-trauma (including drowning and asphyxia) 4 = Unknown | Dominant reason for emergency treatment. |
Indication for airway intervention | 1 = Decreased level of consciousness 2 = Hypoxemia 3 = Ineffective ventilation 4 = Existing airway obstruction 5 = Impending airway obstruction 6 = Combative or uncooperative 7 = Relief of pain or distress 8 = Cardiopulmonary arrest 9 = Other, specify | Dominating indication for airway intervention |
RR initial | Number/ Not recorded | First value recorded by EMS provider on scene |
SBP initial | Number/ Not recorded | First value recorded by EMS provider on scene |
HR initial | Number/ Not recorded | First value recorded by EMS provider on scene |
GCS initial (m/v/e) | Motor 1-6 Verbal 1-5 Eyes 1-4 Not recorded | First value recorded by EMS provider on scene See also GCS definitions |
SpO2 initial, state: with or without supplemental O2 | Number/ Not recorded 1 = Without supplemental O2 2 = With supplemental O2 3 = Unknown if supplemental O2 | First value recorded by EMS provider on scene |
Post-intervention variables
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Post-intervention ventilation | 1 = Spontaneous 2 = Controlled 3 = Mixed 4 = Unknown | How is patient ventilated following airway management? If both spontaneous and controlled choose mixed. |
Post-intervention SBP | Number/ Not recorded | First value recorded by EMS provider after finalised airway management |
Post-intervention SpO2 | Number/ Not recorded | First value recorded by EMS provider after finalised airway management |
Post-intervention EtCO2 | Number/ Not recorded | First value recorded by EMS provider after finalised airway management |
Post-intervention SBP on arrival | Number/ Not recorded | First value recorded by EMS provider after patient arrives at hospital |
Post-intervention SpO2 on arrival | Number/ Not recorded | First value recorded by EMS provider after patient arrives at hospital |
Post-intervention EtCO2 on arrival | Number/ Not recorded | First value recorded by EMS provider after patient arrives at hospital |
Survival status | 1 = Dead on scene or on arrival 2 = Alive on arival 3 = Unknown | Patient survival status: EMS treatment and on arrival hospital |
Attempts at airway intervention | 1 = One attempt 2 = Multiple attempts 3 = Earlier attempts 4 = Unknown | Number of attempts at securing the airway with extraglottic device or ETI. Earlier attempts describe the situation where another EMS personnel has attempted to secure the airway before the current. |
Complications | 1 = ETT misplaced in oesophagus 2 = ETT misplaced in right mainstem bronchus 3 = Teeth trauma 4 = Vomiting and/or aspiration 5 = Hypoxia 6 = Bradycardia 7 = Hypotension 8 = Other, define 9 = None recorded | Problems and mechanical complications recognized on scene and caused by airway management. Physiologic complications (5, 6 and 7) are regarded as such if they were not present before airway intervention and were recorded during or immediately after airway management. The following definitions are to be used: hypoxia: SpO2 <90% bradycardia: pulse rate <60 bpm hypotension: SBP <90 |
Drugs used to facilitate airway procedure | 1 = Sedatives 2 = NMBA 3 = Analgetics/opioids 4 = Local/topic anaesthetic 5 = None | Drugs used to facilitate the airway intervention. Select all that apply. |
Intubation success | 1 = Success on first attempt 2 = Success after more than one attempt and one rescuer 3 = Success after more than one attempt and multiple rescuers 3 = Not successful | Successful intubation defined as tube verified in the trachea. An intubation attempt is defined as attempted laryngoscopy with the intent to intubate |
Device used in successful airway management | 1 = Bag Mask Ventilation 2 = SAD 3 = Oral TI 4 = Nasal TI 5 = Surgical airway 6 = None 7 = Unknown | Device used to manage successful airway or device in place when patient is delivered at hospital/ED |
Data variable name | Data variable categories or values | Definition of data variable |
---|---|---|
Population | Number | Population count in the primary response area of the EMS |
Area | Number | Area in square km or square miles of primary response area of the EMS |
Rural, urban, split | 1 = Urban 2 = Rural 3 = Split | Urban area defined as: "De facto population living in areas classified as urban according to the criteria used by each area or country. Data refer to 1 July of the year indicated and are presented in thousands" Rural area defined as: "De facto population living in areas classified as rural. Data refer to 1 July of the year indicated and are presented in thousands" |
Usual tiered response | Free text | Describe briefly |
Time intervals collected | Free text | Describe briefly |
Mission type | Free text | Describe briefly; e.g. Mainly trauma or mixed patient population |
Times available | Free text | Describe briefly |
Established airway management protocols | Free text | Describe briefly |
Airway management techniques available | Free text | Describe briefly |
Describe type of training in airway management | Describe briefly | |
Type of tracheal tube confirmation technique | 1 = Auscultation 2 = Colorimetry 3 = Capnometry 4 = Capnography 5 = None | |
Type of available ventilator | Free text | Describe briefly |
Materials and methods
Study eligibility criteria
Identification and selection of studies: data extraction
Database | Search terms |
---|---|
"keywords"
| |
Medline | "emergency medical services" AND "intubation, intratracheal" |
EMBASE | "emergency care" AND "intubation/or respiratory tract intubation" |
"title"
| |
Medline | "prehospital" AND "intubation" |
Medline | "pre-hospital" AND "intubation" |
Medline | "out-of-hospital" AND "intubation" |
Medline | "prehospital" AND "RSI" OR "rapid sequence induction" |
Medline | "pre-hospital" AND "RSI" OR "rapid sequence induction" |
Medline | "out-of-hospital" AND "RSI" OR "rapid sequence induction" |
EMBASE | "prehospital" AND "intubation" |
EMBASE | "pre-hospital" AND "intubation" |
EMBASE | "out-of-hospital" AND "intubation" |
EMBASE | "prehospital" AND "RSI" OR "rapid sequence induction" |
EMBASE | "pre-hospital" AND "RSI" OR "rapid sequence induction" |
EMBASE | "out-of-hospital" AND "RSI" OR "rapid sequence induction" |
Study characteristics
Results
Literature search
Characteristics of the included studies
Core variables
Core variables | Number (%) |
---|---|
Core system variables
| |
Main type of transportation | 55 (75%) |
Highest level of EMS provider on scene | 34 (47%) |
Airway device available on scene | 26 (36%) |
Drugs for airway management available on scene | 27 (37%) |
Response time | 10 (14%) |
Core patient variables
| |
Patient category | 63 (86%) |
Age | 59 (81%) |
Gender | 53 (73%) |
GCS initial (m/v/e) | 40 (55%) |
Systolic blood pressure, initial | 35 (48%) |
Indication for airway intervention | 26 (36%) |
Heart rate, initial | 13 (18%) |
Respiratory rate, initial | 12 (16%) |
SpO2 initial, state: with or without supplemental O2 | 11 (15%) |
Co-morbidity | 2 (3%) |
Post intervention variables
| |
Intubation success | 44 (60%) |
Device used in successful airway management | 41 (56%) |
Survival status | 40 (55%) |
Complications | 30 (41%) |
Drugs used to facilitate airway procedure | 28 (38%) |
Attempts at airway intervention | 25 (34%) |
Post-intervention SBP on arrival | 11 (15%) |
Post-intervention SpO2 on arrival | 10 (14%) |
Post-intervention EtCO2 on arrival | 8 (11%) |
Post-intervention SBP | 8 (11%) |
Post-intervention SpO2 | 8 (11%) |
Post-intervention ventilation | 3 (4%) |
Post-intervention EtCO2 | 3 (4%) |
Fixed system variables
| |
Service mission types | 52 (71%) |
Established airway management protocols | 48 (66%) |
Area | 40 (55%) |
Usual tiered response | 33 (45%) |
Type of tracheal tube confirmation technique | 31 (42%) |
Rural, urban, split | 31 (42%) |
Airway management techniques available | 30 (41%) |
Population | 24 (33%) |
Describe type of training in airway management | 23 (32%) |
Time intervals collected | 15 (21%) |
Times available | 13 (18%) |
Type of available ventilator | 1 (1%) |
Fixed-system variables
Discussion
Limitations
Conclusions
Key messages
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Studies investigating pre-hospital TI in adults lack the core data required for useful interpretation of results.
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The published studies investigating pre-hospital TI rarely present high-quality scientific evidence.
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Pre-hospital TI is a complex intervention, and terminology and study design must be developed to substantiate future evidence-based clinical practice.
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A recently published template for reporting advanced pre-hospital airway management might be a first and important step in this direction.