Annals of Emergency Medicine
Volume 55, Issue 6 , Pages 527-537.e6 , June 2010

Out-of-Hospital Endotracheal Intubation Experience and Patient Outcomes

Presented at the National Association of EMS Physicians annual meeting, January 2009, Jacksonville, FL.

  • Henry E. Wang, MD, MS

      Affiliations

    • Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL
    • Corresponding Author InformationAddress for correspondence: Henry E. Wang, MD, MS, Department of Emergency Medicine, University of Alabama at Birmingham, 619 19th Street South, JTN 266, Birmingham, AL 35249; 205-996-6526, fax 205-975-4662
  • ,
  • G.K. Balasubramani, PhD

      Affiliations

    • Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
  • ,
  • Lawrence J. Cook, PhD

      Affiliations

    • Intermountain Injury Control and Research Center, Department of Pediatrics, University of Utah, Salt Lake City, UT
  • ,
  • Judith R. Lave, PhD

      Affiliations

    • Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA
  • ,
  • Donald M. Yealy, MD

      Affiliations

    • Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA

Received 7 April 2009 ,Revised 1 December 2009 ,Accepted 11 December 2009.

References 

  1. Jacobs LM, Berrizbeitia LD, Bennett B, et al. Endotracheal intubation in the prehospital phase of emergency medical care. JAMA. 1983;250:2175–2177
  2. Stewart RD, Paris PM, Winter PM, et al. Field endotracheal intubation by paramedical personnel (Success rates and complications). Chest. 1984;85:341–345
  3. De Leo BC. Endotracheal intubation by rescue squad personnel. Heart Lung. 1977;6:851–854
  4. Guss DA, Posluszny M. Paramedic orotracheal intubation: a feasibility study. Am J Emerg Med. 1984;2:399–401
  5. Wang HE, Kupas DF, Greenwood MJ, et al. An algorithmic approach to prehospital airway management. Prehosp Emerg Care. 2005;9:145–155
  6. Katz SH, Falk JL. Misplaced endotracheal tubes by paramedics in an urban emergency medical services system. Ann Emerg Med. 2001;37:32–37
  7. Wang HE, Lave JR, Sirio CA, et al. Paramedic intubation errors: isolated events or symptoms of larger problems?. Health Aff (Millwood). 2006;25:501–509
  8. Wang HE, Yealy DM. How many attempts are required to accomplish out-of-hospital endotracheal intubation?. Acad Emerg Med. 2006;13:372–377
  9. Davis DP, Dunford JV, Poste JC, et al. The impact of hypoxia and hyperventilation on outcome after paramedic rapid sequence intubation of severely head-injured patients. J Trauma. 2004;57:1–8discussion 8-10
  10. Aufderheide TP, Lurie KG. Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med. 2004;32(9 suppl):S345–S351
  11. Aufderheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation. 2004;109:1960–1965
  12. Luft HS. Hospital Volume, Physician Volume, and Patient Outcomes: Assessing the Evidence. Ann Arbor, MI: Health Administration Press; 1990;
  13. Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? (a systematic review and methodologic critique of the literature). Ann Intern Med. 2002;137:511–520
  14. Kelly JV, Hellinger FJ. Heart disease and hospital deaths: an empirical study. Health Serv Res. 1987;22:369–395
  15. MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354:366–378
  16. Nathens AB, Jurkovich GJ, Maier RV, et al. Relationship between trauma center volume and outcomes. JAMA. 2001;285:1164–1171
  17. Smith RF, Frateschi L, Sloan EP, et al. The impact of volume on outcome in seriously injured trauma patients: two years' experience of the Chicago Trauma System. J Trauma. 1990;30:1066–1075discussion 1075-1076
  18. Spaite D, Benoit R, Brown D, et al. Uniform prehospital data elements and definitions: a report from the Uniform Prehospital Emergency Medical Services Data Conference. Ann Emerg Med. 1995;25:525–531
  19. Pennsylvania Health Care Cost Containment Council. http://www.phc4.orgAccessed March 20, 2008
  20. Pennsylvania Department of Health, Bureau of Health Statistics and Research, Death registration. http://www.portal.state.pa.us/portal/server.pt/community/death_registration/14278Accessed January 8, 2010
  21. Fellegi I, Sunter A. A theory for record linkage. J Am Stat Assoc. 1969;64:1183–1210
  22. Jaro MA. Probabilistic linkage of large public health data files. Stat Med. 1995;14:491–498
  23. Newcombe H, Kennedy J. Record linkage. Commun Assoc Computing Machinery. 1962;5:563–566
  24. Newgard CD. Validation of probabilistic linkage to match de-identified ambulance records to a state trauma registry. Acad Emerg Med. 2006;13:69–75
  25. Cercarelli LR, Rosman DL, Ryan GA. Comparison of accident and emergency with police road injury data. J Trauma. 1996;40:805–809
  26. Overpeck MD, Hoffman HJ, Prager K. The lowest birth-weight infants and the US infant mortality rate: NCHS 1983 linked birth/infant death data. Am J Public Health. 1992;82:441–444
  27. Henderson J, Goldacre MJ, Graveney MJ, et al. Use of medical record linkage to study readmission rates. BMJ. 1989;299:709–713
  28. Goldacre MJ, Simmons H, Henderson J, et al. Trends in episode based and person based rates of admission to hospital in the Oxford record linkage study area. Br Med J (Clin Res Ed). 1988;296:583–585
  29. Henderson J, Goldacre MJ, Griffith M. Hospital care for the elderly in the final year of life: a population based study. BMJ. 1990;301:17–19
  30. Newman TB, Brown AN. Use of commercial record linkage software and vital statistics to identify patient deaths. J Am Med Inform Assoc. 1997;4:233–237
  31. Cook LJ, Knight S, Olson LM, et al. Motor vehicle crash characteristics and medical outcomes among older drivers in Utah, 1992-1995. Ann Emerg Med. 2000;35:585–591
  32. McGlincy MH. A bayesian record linkage methodology for multiple imputation of missing links. In: ASA Proceedings of the Joint Statistical Meetings. Alexandria, VA: American Statistical Association; 2004;p. 4001–4008
  33. Cook LJ, Olson LM, Dean JM. Probabilistic record linkage: relationships between file sizes, identifiers and match weights. Methods Inf Med. 2001;40:196–203
  34. Rubin DB, Schenker N. Multiple imputation in health-care databases: an overview and some applications. Stat Med. 1991;10:585–598
  35. Little RJA, Rubin DB. Statistical Analysis With Missing Data. 2nd ed.. Hoboken, NJ: Wiley; 2002;
  36. Sakles JC, Laurin EG, Rantapaa AA, et al. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med. 1998;31:325–332
  37. Stiell IG, Wells GA, DeMaio VJ, et al. Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS Study Phase I results. Ontario Prehospital Advanced Life Support. Ann Emerg Med. 1999;33:44–50
  38. Ricketts TC. Rural Health in the United States. New York, NY: Oxford University Press; 1999;
  39. Hardin JW, Hilbe J. Generalized Estimating Equations. Boca Raton, FL: Chapman & Hall/CRC; 2002;
  40. Nichol G, Thomas E, Callaway CW, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA. 2008;300:1423–1431
  41. Wang HE, Kupas DF, Paris PM, et al. Preliminary experience with a prospective, multi-centered evaluation of out-of-hospital endotracheal intubation. Resuscitation. 2003;58:49–58
  42. Wang HE, O'Connor RE, Schnyder ME, et al. Patient status and time to intubation in the assessment of prehospital intubation performance. Prehosp Emerg Care. 2001;5:10–18
  43. Garza AG, Gratton MC, Coontz D, et al. Effect of paramedic experience on orotracheal intubation success rates. J Emerg Med. 2003;25:251–256
  44. Wang HE, Simeone SJ, Weaver MD, et al. Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation. Ann Emerg Med. 2009;54:645–652e641
  45. Baker SP, Neill BO, Haddon W, et al. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–196
  46. Davis DP, Hoyt DB, Ochs M, et al. The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury. J Trauma. 2003;54:444–453
  47. Wayne MA, Friedland E. Prehospital use of succinylcholine: a 20-year review. Prehosp Emerg Care. 1999;3:107–109
  48. Wang HE, Davis DP, O'Connor RE, et al. Drug-assisted intubation in the prehospital setting (resource document to NAEMSP position statement). Prehosp Emerg Care. 2006;10:261–271
  49. Wang HE, Yealy DM. Out-of-hospital endotracheal intubation: where are we?. Ann Emerg Med. 2006;47:532–541
  50. Wang HE, Kupas DF, Hostler D, et al. Procedural experience with out-of-hospital endotracheal intubation. Crit Care Med. 2005;33:1718–1721
  51. Johnston BD, Seitz SR, Wang HE. Limited opportunities for paramedic student endotracheal intubation training in the operating room. Acad Emerg Med. 2006;13:1051–1055
  52. Hall RE, Plant JR, Bands CJ, et al. Human patient simulation is effective for teaching paramedic students endotracheal intubation. Acad Emerg Med. 2005;12:850–855
  53. Wang HE, Yealy DM. Human patients or simulators for teaching endotracheal intubation: whom are we fooling?. Acad Emerg Med. 2006;13:232;author reply 232-233
  54. Persse DE, Key CB, Bradley RN, et al. Cardiac arrest survival as a function of ambulance deployment strategy in a large urban emergency medical services system. Resuscitation. 2003;59:97–104
  55. Thomas JB, Abo BN, Wang HE. Paramedic perceptions of challenges in out-of-hospital endotracheal intubation. Prehosp Emerg Care. 2007;11:219–223

 Supervising editors: Kathy J. Rinnert, MD, MPH; Michael L. Callaham, MD

 Dr. Rinnert and Dr. Callaham were the supervising editors on this article. Dr. Yealy did not participate in the editorial review or decision to publish this article.

 Author contributions: HEW conceived the study. HEW, JRL, and DMY designed the study. HEW obtained the data. LJC performed data set linkage. HEW, GKB, and LJC performed the analysis. 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 R21-HL084528. 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.

 Publication date: Available online February 5, 2010.

 Reprints not available from the authors.

 Please see page 528 for the Editor's Capsule Summary of this article.

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

PII: S0196-0644(09)01841-1

doi: 10.1016/j.annemergmed.2009.12.020

Annals of Emergency Medicine
Volume 55, Issue 6 , Pages 527-537.e6 , June 2010