Performance of a Difficult Airway Algorithm in the Prehospital Setting

Although providers adhered to the algorithm, complication rates were high.

In a prospective observational study, researchers evaluated adherence to a difficult intubation management algorithm by a prehospital emergency medical services unit in France between 2005 and 2009. All intubations were performed by a physician (attending or senior resident) and nurse anesthetist. In cases of difficult intubation, the algorithm recommended use of a gum elastic bougie (GEB) first and an intubating laryngeal mask airway (ILMA) second. If intubation or ventilation (O₂ saturation maintained above 85%) was impossible, the algorithm recommended use of an ILMA, followed by cricothyroidotomy if the ILMA failed.

Overall, 160 of 2674 intubations (6%) were difficult. Rate of adherence to the algorithm was 98%. The algorithm was not adh…

Reviewing Authors

Emily L. Brown, MD

Ron M. Walls, MD, FRCPC, FAAEM

Disclosures

Speaker's bureauAirway Management Education Center, LLC

EquityAirway Management Education Center, LLC

Grant / Research supportAgency for Health Care Research and Quality

Editorial boardsManual of Emergency Airway Management; Rosen's Emergency Medicine; UpToDate; Scientific American Medicine