Paramedics attitudes toward endotracheal intibation

(1)

Sir,

The endotracheal intubation is the most desired method to secure the airway patency [1]. Many scienti_{ﬁc societies in the ﬁeld of} emer-gency medicine currently indicate endotracheal intubation as the “gold standard” of securing respiratory airway in an emergency. The purpose of direct laryngoscopy is to push aside both the tongue and soft tissues of the throat in order to visualize the glottis which allows for the insertion of tracheal tube into the trachea [2,3].

In their 2015 guidelines the ERC (European Resuscitation Council) recommends the endotracheal intubation in all cases of cardiac arrest. These guidelines greatly emphasize minimizing the breaks during chest compressions, as a factor that directly affects the survival of pa-tients in a state of sudden cardiac arrest, which therefore improves the efﬁciency of cardiopulmonary resuscitation. Hence, the person performing endotracheal intubation should either perform this proce-dure while continuously compressing the chest or only with a short break to allow the insertion of the endotracheal tube between the vocal folds. Therefore, numerous studies recommend that endotracheal intubation should be performed by the most experienced person [4,5].

Endotracheal intubation carries a lot of beneﬁts and a risk of poten-tial complications [6]. The possibility of performing continuous chest compressions while intubating the patient is among unquestionable beneﬁts as it allows for minimizing the breaks during compressions and increases the organ perfusion. Another advantage is the possibility to constantly monitor the carbon dioxide concentration in the exhaled air with capnometry and ventilating with positive end-expiratory pres-sure (PEEP). It was also possible until recently to administer resuscitat-ing drugs through the endotracheal tube when there was no possibility for vascular access. However, this method is not recommended by the current guidelines of the European Resuscitation Council (ERC) and the American Heart Association (AHA) as there is no method to predict the pharmacodynamics of the endobronchialy administered drugs.

In the study performed from July to November 2017 a questionnaire was sent to 220 paramedics. It consisted of questions regarding the atti-tude toward usage of various types of laryngoscopes in pre-hospital conditions. 100% of paramedics declared the possession of Macintosh and Miller blades in emergency medical rescue teams. 65% of partici-pants have attended the courses during which issues related to the use of video laryngoscopes were discussed. 98% of those who have ex-perience in video laryngoscopy would use this method of intubation as the method of choice when providing help in pre-hospital conditions. 92.3% of participants declared a will to participate in video laryngoscopy course devoted to adult intubation while 100% declared a will to partic-ipate in pediatric video laryngoscopy course.

Togay Evrin, PhD, MD Department of Emergency Medicine, UFuK University Medical Faculty, Ankara, Turkey Halla Kaminska, PhD, MD Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland Wojciech Wieczorek, MSc, EMT-P Department of Anaesthesiology, Intensive Care and Emergency Medicine in Zabrze, Medical University of Silesia, Katowice, Poland Corresponding author at: Department of Anaesthesiology and Intensive Therapy, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 3 Maja 13/15 Str., 41-800 Zabrze, Poland. E-mail address:wieczorekwojciech.pl@gmail.com. https://doi.org/10.1016/j.ajem.2018.01.053

16 January 2018 Available online xxxx

References

[1] Klosiewicz T, Sip M, Zalewski R, Zielinski M. Alternative of endotracheal intubation for paramedics to provide direct laryngoscopy. The randomized manikin trial. Dis Emerg Med J 2017;2(3):142–4.https://doi.org/10.5603/DEMJ.a2017.0032.

[2] Bielski K, Smereka J, Ladny JR, Szarpak L. A comparison of the Macintosh laryngoscope and blind intubation via I-gel in intubating an entrapped patient: a randomized cross-over manikin study. Am J Emerg Med 2017;35(5):787–9.https://doi.org/10.1016/j. ajem.2016.11.048.

[3] Smereka J, Ladny JR, Naylor A, Ruetzler K, Szarpak L. C-MAC compared with direct lar-yngoscopy for intubation in patients with cervical spine immobilization: a manikin trial. Am J Emerg Med 2017 Aug;35(8):1142–6.https://doi.org/10.1016/j.ajem.2017. 03.030.

[4] Karczewska K, Szarpak L, Smereka J, Dabrowski M, Ladny JR, Wieczorek W, et al. ET-View compared to direct laryngoscopy in patients with immobilized cervical spine by unexperienced physicians: a randomized crossover manikin trial. Anaesthesiol Inten-sive Ther 2017;49(4):274–82.https://doi.org/10.5603/AIT.a2017.0047.

[5] Ladny JR, Smereka J, Szarpak L. Comparison of the Trachway video intubating stylet and Macintosh laryngoscope for endotracheal intubation. Preliminary data. Am J Emerg Med 2017;35(4):574–5.https://doi.org/10.1016/j.ajem.2016.12.015. [6]Truszewski Z, Krajewski P, Fudalej M, Smereka J, Frass M, Robak O, et al. A comparison

of a traditional endotracheal tube versus ETView SL in endotracheal intubation during different emergency conditions: a randomized, crossover cadaver trial. Medicine (Bal-timore) 2016 Nov;95(44):e5170.

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Please cite this article as: Evrin T, et al, Paramedics attitudes toward endotracheal intibation, American Journal of Emergency Medicine (2018), https://doi.org/10.1016/j.ajem.2018.01.053