A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa
Dublin Core
Title
A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa
Subject
Prehospital emergency care, Airway management, Endotracheal intubation, South Africa
Description
Introduction: Prehospital advanced airway management, including endotracheal intubation (ETI), is one of the most
commonly performed advanced life support skills. In South Africa, prehospital ETI is performed by non-physician
prehospital providers. This practice has recently come under scrutiny due to lower frst pass (FPS) and overall success
rates, a high incidence of adverse events (AEs), and limited evidence regarding the impact of ETI on mortality. The aim
of this study was to describe non-physician ETI in a South African national sample in terms of patient demographics,
indications for intubation, means of intubation and success rates. A secondary aim was to determine what factors
were predictive of frst pass success.
Methods: This study was a retrospective chart review of prehospital ETIs performed by non-physician prehospital
providers, between 01 January 2017 and 31 December 2017. Two national private Emergency Medical Services (EMS)
and one provincial public EMS were sampled. Data were analysed descriptively and summarised. Logistic regression
was performed to evaluate factors that afect the likelihood of FPS.
Results: A total of 926 cases were included. The majority of cases were adults (n =781, 84.3%) and male (n =553,
57.6%). The most common pathologies requiring emergency treatment were head injury, including traumatic
brain injury (n =328, 35.4%), followed by cardiac arrest (n =204, 22.0%). The mean time on scene was 46minutes
(SD=28.3). The most cited indication for intubation was decreased level of consciousness (n =515, 55.6%), followed
by cardiac arrest (n =242, 26.9%) and inefective ventilation (n =96, 10.4%). Rapid sequence intubation (RSI, n =344,
37.2%) was the most common approach. The FPS rate was 75.3%, with an overall success rate of 95.7%. Intubation
failed in 33 (3.6%) patients. The need for ventilation was inversely associated with FPS (OR=0.42, 95% CI: 0.20–0.88,
p =0.02); while deep sedation (OR=0.56, 95% CI: 0.36–0.88, p =0.13) and no drugs (OR=0.47, 95% CI: 0.25–0.90,
p =0.02) compared to RSI was less likely to result in FPS. Increased scene time (OR=0.99, 95% CI: 0.985–0.997,
p <0.01) was inversely associated FPS.
commonly performed advanced life support skills. In South Africa, prehospital ETI is performed by non-physician
prehospital providers. This practice has recently come under scrutiny due to lower frst pass (FPS) and overall success
rates, a high incidence of adverse events (AEs), and limited evidence regarding the impact of ETI on mortality. The aim
of this study was to describe non-physician ETI in a South African national sample in terms of patient demographics,
indications for intubation, means of intubation and success rates. A secondary aim was to determine what factors
were predictive of frst pass success.
Methods: This study was a retrospective chart review of prehospital ETIs performed by non-physician prehospital
providers, between 01 January 2017 and 31 December 2017. Two national private Emergency Medical Services (EMS)
and one provincial public EMS were sampled. Data were analysed descriptively and summarised. Logistic regression
was performed to evaluate factors that afect the likelihood of FPS.
Results: A total of 926 cases were included. The majority of cases were adults (n =781, 84.3%) and male (n =553,
57.6%). The most common pathologies requiring emergency treatment were head injury, including traumatic
brain injury (n =328, 35.4%), followed by cardiac arrest (n =204, 22.0%). The mean time on scene was 46minutes
(SD=28.3). The most cited indication for intubation was decreased level of consciousness (n =515, 55.6%), followed
by cardiac arrest (n =242, 26.9%) and inefective ventilation (n =96, 10.4%). Rapid sequence intubation (RSI, n =344,
37.2%) was the most common approach. The FPS rate was 75.3%, with an overall success rate of 95.7%. Intubation
failed in 33 (3.6%) patients. The need for ventilation was inversely associated with FPS (OR=0.42, 95% CI: 0.20–0.88,
p =0.02); while deep sedation (OR=0.56, 95% CI: 0.36–0.88, p =0.13) and no drugs (OR=0.47, 95% CI: 0.25–0.90,
p =0.02) compared to RSI was less likely to result in FPS. Increased scene time (OR=0.99, 95% CI: 0.985–0.997,
p <0.01) was inversely associated FPS.
Creator
Craig A. Wylie, Farzana Araie, Clint Hendrikse, Jan Burke, Ivan Joubert, Anneli Hardy and Willem Stassen
Publisher
BMC Emergency Medicine
Date
(2022) 22:129
Contributor
Fajar Bagus W
Format
PDF
Language
English
Type
Text
Files
Collection
Citation
Craig A. Wylie, Farzana Araie, Clint Hendrikse, Jan Burke, Ivan Joubert, Anneli Hardy and Willem Stassen, “A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/4121.