Patient positioning and airway management in the pre-hospital setting: an observational study

Abstract

Abstract published with permission. Background – Pre-hospital airway management is often carried out in unconventional and challenging settings. The position of the patient requires the clinician to adjust the working position in order to get optimal visualisation. Aim and objective – This study aims to determine whether patient positioning affects the time to ventilation by tracheal intubation and the insertion of a supraglottic device in order to optimise airway management and reduce the period of hypoxia. The objective is also to compare the results of paramedics with the results of specialised critical care paramedics in order to ascertain whether additional training affects the time to ventilation in different positions. Methods – A sample of seven paramedics and seven critical care paramedics was recruited on a voluntary basis. The paramedics were timed while intubating with an endotracheal tube and inserting a supraglottic device, i-gel, from three different positions: lying down on the floor, kneeling in front of an ambulance trolley and standing with the trolley adjusted to the paramedic’s preferred height. Results – On average, both paramedics and critical care paramedics intubated from a lying down position in 26 seconds. The critical care paramedics were on average quicker than the paramedics from the kneeling and standing positions. The quickest paramedic intubation attempt was from a lying down position in 26 seconds, whereas the quickest critical care paramedic intubation attempt from a standing position by a height-adjusted trolley took 20 seconds. Conclusion – Both paramedics and critical care paramedics intubate from a lying down position in the same time. The critical care paramedics were on average quicker than the paramedics from the kneeling and standing positions. The critical care paramedics were more consistent in all their attempts, with less of a performance gap among themselves. The variation in time to ventilate among paramedics showed huge differences in the paramedics’ overall performance.