Drug-free tracheal intubation by specialist paramedics (critical care) in a United Kingdom ambulance service: a service evaluation

Drug-free tracheal intubation by specialist paramedics (critical care) in a United Kingdom ambulance service: a service evaluation

Tracheal intubation, Intubation, Airway, Paramedic, Prehospital, Critical care

Background: Drug-free tracheal intubation has been a common intervention in the context of out-of-hospital
cardiac arrest for many years, however its use by paramedics has recently been the subject of much debate. Recent
international guidance has recommended that only those achieving high tracheal intubation success should
continue to use it.
Methods: We conducted a retrospective service evaluation of all drug-free tracheal intubation attempts by
specialist paramedics (critical care) from South East Coast Ambulance Service NHS Foundation Trust between 1st
January and 31st December 2019. Our primary outcome was first-pass success rate, and secondary outcomes were
success within two attempts, overall success, Cormack-Lehane grade of view, and use of bougie.
Results: There were 663 drug-free tracheal intubations and following screening, 605 were reviewed. There was a
first-pass success rate of 81.5%, success within two attempts of 96.7%, and an overall success rate of 98.35%. There
were ten unsuccessful attempts (1.65%). Bougie use was documented in 83.4% on the first attempt, 93.5% on the
second attempt and 100% on the third attempt,
Conclusion: Specialist paramedics (critical care) are able to deliver drug-free tracheal intubation with good first-pass
success and high overall success and are therefore both safe and competent at this intervention.

Silas Houghton Budd , Eleanor Alexander-Elborough, Richard Brandon, Chris Fudge, Scott Hardy, Laura Hopkins, Ben Paul, Sloane Philips, Sarah Thatcher and Paul Winso

BMC Emergency Medicine

(2021) 21:144

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