Maybe Paramedics Should Not Perform Endotracheal Intubation

Two large studies add to mounting evidence that endotracheal intubation by paramedics may not be the best course.

Prior research has cast doubt on the value of endotracheal intubation of cardiac arrest patients by paramedics (NEJM JW Emerg Med Apr 2018 and JAMA 2018; 319:779). Researchers in the U.S. and England now report two separate, large cluster-randomized trials that compared outcomes when paramedics performed endotracheal intubation versus placed a supraglottic airway device.

In the U.S. trial, 27 emergency medical services (EMS) agencies were randomized in 13 clusters to initial airway management with a supraglottic laryngeal tube (1505 patients) or endotracheal intubation (1499 patients), with crossover to the alternate strategy every few months. The initial attempt to secure the airway was successful in 90% of patients with the supraglottic ap…

Reviewing Author

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Maybe Paramedics Should Not Perform Endotracheal Intubation

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Reviewing Author