Interruptions in Cardiopulmonary Resuscitation From Paramedic Endotracheal Intubation
Presented at the Society for Academic Emergency Medicine annual meeting, May 2008, Washington, DC.
Received 16 December 2008; received in revised form 1 March 2009 and 14 May 2009; accepted 21 May 2009. published online 03 July 2009.
Refers to article:
Do Not Pardon the Interruption
, 03 August 2009
Bentley J. Bobrow, Daniel W. Spaite
Annals of Emergency Medicine
November 2009 (Vol. 54, Issue 5, Pages 653-655) Full Text |
Full-Text PDF (122 KB)
Study objective
Emergency cardiac care guidelines emphasize treatment of cardiopulmonary arrest with continuous uninterrupted cardiopulmonary resuscitation (CPR) chest compressions. Paramedics in the United States perform endotracheal intubation on nearly all victims of out-of-hospital cardiopulmonary arrest. We quantified the frequency and duration of CPR chest compression interruptions associated with paramedic endotracheal intubation efforts during out-of-hospital cardiopulmonary arrest.
Methods
We studied adult out-of-hospital cardiopulmonary arrest treated by an urban and a rural emergency medical services agency from the Resuscitation Outcomes Consortium during November 2006 to June 2007. Cardiac monitors with compression sensors continuously recorded rescuer CPR chest compressions. A digital audio channel recorded all resuscitation events. We identified CPR interruptions related to endotracheal intubation efforts, including airway suctioning, laryngoscopy, endotracheal tube placement, confirmation and adjustment, securing the tube in place, bag-valve-mask ventilation between intubation attempts, and alternate airway insertion. We identified the number and duration of CPR interruptions associated with endotracheal intubation efforts.
Results
We included 100 of 182 out-of-hospital cardiopulmonary arrests in the analysis. The median number of endotracheal intubation–associated CPR interruption was 2 (interquartile range [IQR] 1 to 3; range 1 to 9). The median duration of the first endotracheal intubation–associated CPR interruption was 46.5 seconds (IQR 23.5 to 73 seconds; range 7 to 221 seconds); almost one third exceeded 1 minute. The median total duration of all endotracheal intubation–associated CPR interruptions was 109.5 seconds (IQR 54 to 198 seconds; range 13 to 446 seconds); one fourth exceeded 3 minutes. Endotracheal intubation–associated CPR pauses composed approximately 22.8% (IQR 12.6-36.5%; range 1.0% to 93.4%) of all CPR interruptions.
Conclusion
In this series, paramedic out-of-hospital endotracheal intubation efforts were associated with multiple and prolonged CPR interruptions.
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
Address for correspondence: Henry E. Wang, MD, MS, Department of Emergency Medicine, University of Alabama at Birmingham, 619 19th St South, JTN 266, Birmingham, AL 35249; 205-996-6526, fax 205-975-4662
Dr. Wang is now affiliated with the Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL.
Supervising editor: Daniel W. Spaite, MD
Author contributions: HEW and CWC conceived the study. HEW, SJS, and CWC designed the study. SJS and MDW abstracted the data. HEW, SJS, and MDW analyzed the data. HEW drafted the article, and all authors contributed substantially to its revision. HEW had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. HEW takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was supported by National Heart, Lung, and Blood Institute grant U01-HL077871. Dr. Wang received support from Clinical Scientist Development Award K08-HS013628 from the Agency for Health Care Research and Quality, Rockville, MD. The funders had no direct role in the design or execution of the study or the composition of the resulting article.
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