Training and experience are more important than the type of practitioner for intubation success
© BioMed Central Ltd 2013
Published: 8 February 2013
Predictors of intubation success, univariate versus multivariate regression model
Unadjusted success difference
Adjusted success difference
Training of clinician (reference: lower experience)
EMS manning (reference: physician)
RSI (reference: no RSI)
EMS, emergency medical service; RSI, rapid sequence induction.
Lossius and colleagues compared ETI success rates of highly trained anaesthesiologists and emergency physicians from northwestern Europe with paramedics and nurses from the rest of the world . One study incorporated in their meta-analysis included rural basic emergency medical technicians with no previous ETI experience . Perhaps unsurprisingly, the authors showed increased ETI success rates for highly trained physicians compared with such a varied group of nonphysicians. However, our re-analysis suggests that the differing level of ETI training between clinicians, not the type of clinician, might be more important for successful ETI.
Hans Morten Lossius, David J Lockey and Jo Røislien
Thank you for your interest in our recently published paper . Our article makes it quite clear that we consider training of key importance in intubation success rates. While training may be more important than the type of provider, the type of provider is often a marker of level of training. We point out that there is considerable variability in paramedic training, and to a lesser extent physician training, in different emergency medicine systems. However, well-trained anaesthesiologists are likely to have more training and experience in advanced airway management than even well-trained paramedics. We looked at one large study involving paramedics trained to a high level, higher than most emergency medicine systems are able to resource, and found that intubation failure rates were higher than for undifferentiated physician intubation. We believe our publication provides evidence that paramedics, even with good training but limited regular exposure to advanced airway management, have a higher intubation failure rate than physicians with high exposure to in-hospital and out-of-hospital advanced airway management.
Advanced airway management must be considered a complex intervention in which the ETI procedure is one of many factors influencing outcome [3, 4]. In-hospital advanced airway management is the responsibility of specialist physicians working in high-dependency units. Prehospital advanced airway management is even more challenging due to environmental factors and arbitrary patient information. Successful airway management is dependent on a comprehensive understanding of pathophysiological processes and high competence in advanced corrective interventions, and is not equivalent to good technical skills in ETI alone.
- Lossius HM, Røislien J, Lockey DJ: Patient safety in pre-hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers. Crit Care 2012, 16: R24. 10.1186/cc11189PubMed CentralView ArticlePubMed
- Bradley JS, Billows GL, Olinger ML, Boha SP, Cordell WH, Nelson DR: Prehospital oral endotracheal intubation by rural basic emergency medical technicians. Ann Emerg Med 1998, 32: 26-32. 10.1016/S0196-0644(98)70095-2View ArticlePubMed
- Lossius HM, Sollid SJ, Rehn M, Lockey DJ: Revisiting the value of pre-hospital tracheal intubation: an all time systematic literature review extracting the Utstein airway core variables. Crit Care 2011, 15: R26. 10.1186/cc9973PubMed CentralView ArticlePubMed
- Sollid SJ, Lockey DJ, Lossius HM, Pre-hospital advanced airway management expert group: A consensus-based template for uniform reporting of data from pre-hospital advanced airway management. Scand J Trauma Resusc Emerg Med 2009, 17: 58. 10.1186/1757-7241-17-58PubMed CentralView ArticlePubMed