PMID- 35842578
OWN - NLM
STAT- MEDLINE
DCOM- 20220719
LR  - 20220731
IS  - 1471-227X (Electronic)
IS  - 1471-227X (Linking)
VI  - 22
IP  - 1
DP  - 2022 Jul 16
TI  - A retrospective descriptive analysis of non-physician-performed prehospital 
      endotracheal intubation practices and performance in South Africa.
PG  - 129
LID - 10.1186/s12873-022-00688-4 [doi]
LID - 129
AB  - 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 first 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 first 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 affect 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 46 minutes 
      (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 
      ineffective 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. CONCLUSION: This is one of the first and largest 
      studies evaluating prehospital ETI in Africa. In this sample of ground-based EMS 
      non-physician ETI, we found success rates similar to those reported in the 
      literature. More research is needed to determine AE rates and the impact of ETI 
      on patient outcome. There is an urgent need to standardise prehospital ETI 
      reporting in South Africa to facilitate future research.
CI  - (c) 2022. The Author(s).
FAU - Wylie, Craig A
AU  - Wylie CA
AD  - Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
FAU - Araie, Farzana
AU  - Araie F
AD  - Department of Anaesthesia and Perioperative Medicine, University of Cape Town, 
      Cape Town, South Africa.
FAU - Hendrikse, Clint
AU  - Hendrikse C
AD  - Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
FAU - Burke, Jan
AU  - Burke J
AD  - Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
FAU - Joubert, Ivan
AU  - Joubert I
AD  - Department of Anaesthesia and Perioperative Medicine, University of Cape Town, 
      Cape Town, South Africa.
FAU - Hardy, Anneli
AU  - Hardy A
AD  - Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
FAU - Stassen, Willem
AU  - Stassen W
AUID- ORCID: 0000-0002-1486-4446
AD  - Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa. 
      willem.stassen@uct.ac.za.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220716
PL  - England
TA  - BMC Emerg Med
JT  - BMC emergency medicine
JID - 100968543
SB  - IM
MH  - Adult
MH  - *Emergency Medical Services
MH  - *Heart Arrest
MH  - Humans
MH  - Intubation, Intratracheal
MH  - Male
MH  - Retrospective Studies
MH  - South Africa
PMC - PMC9287876
OTO - NOTNLM
OT  - Airway management
OT  - Endotracheal intubation
OT  - Prehospital emergency care
OT  - South Africa
COIS- The authors declare that they have no competing interests.
EDAT- 2022/07/17 06:00
MHDA- 2022/07/20 06:00
PMCR- 2022/07/16
CRDT- 2022/07/16 23:24
PHST- 2021/12/29 00:00 [received]
PHST- 2022/07/04 00:00 [accepted]
PHST- 2022/07/16 23:24 [entrez]
PHST- 2022/07/17 06:00 [pubmed]
PHST- 2022/07/20 06:00 [medline]
PHST- 2022/07/16 00:00 [pmc-release]
AID - 10.1186/s12873-022-00688-4 [pii]
AID - 688 [pii]
AID - 10.1186/s12873-022-00688-4 [doi]
PST - epublish
SO  - BMC Emerg Med. 2022 Jul 16;22(1):129. doi: 10.1186/s12873-022-00688-4.