Pre-hospital tracheal intubation assisted by fibroscopy in patients with suspicion of cervical spine lesion: a pilot study

Introduction

There is still some controversy about the best manner to manage, in the pre-hospital phase, the patients requesting tracheal intubation and suspected to suffer from a cervical spine lesion. The present observation reports the use of a new, entirely autonomous, equipment for in the field tracheal fibroscopy.

Methodology

An anaesthetist, trained to tracheal fibroscopy, has at his disposal a medical vehicle and the equipment for emergency pre-hospital tracheal intubation.

Results

Five patients were intubated with the 'in the field' tracheal fibroscope (9, 16, 21, 22 and 62 years of age). The intubation was carried out without any problem on 4 victims despite their spine was immobilised with a cervical collar and that blood was present in the pharynx. One intubation proved itself to be more difficult on a patient who had undergone several unsuccessful and traumatising attempts by the first physician on the scene.

Discussion

Some practical details seem to be at importance for correct management of a fibroscopic guided tracheal intubation in the pre-hospital environment. First, the quality of the images transmitted by the fiberoptic equipment; second, the oxygenation of the patient during the tracheal intubation process; third, the aseptic aspects of this manoeuvre; fourth, the 'ready to use' aspect of the associated material (gloves, suction); fifth, the training level of the physician in charge of the tracheal intubation process; sixth, the level of accompanying analgesia or anaesthesia.

Conclusion

As tracheal intubation through fibroscopy could be a 'gentle' technique, the use of 'in the field' fibroscopic equipment would be encouraged in a pre-hospital phase to reduce the risk of hypoxaemia associated with many difficult tracheal intubations and the severity of pharyngeal and laryngeal trauma produced by the 'classical' direct vision laryngoscope.