Paramedic intubation during a pandemic: Where are the consensus guidelines?
PDF

Keywords

paramedic
intubation
COVID-19
pandemic

How to Cite

1.
Armour RD, Helmer J, Deakin J. Paramedic intubation during a pandemic: Where are the consensus guidelines?. Australasian Journal of Paramedicine [Internet]. 2020Apr.22 [cited 2023Mar.30];17. Available from: https://ajp.paramedics.org/index.php/ajp/article/view/806

Abstract

There is no denying that paramedic-led intubation is a contentious issue in out-of-hospital care. Guidelines for the management of COVID-19 are developed with both patient-centred care as well as provider safety in mind, with intubation the preferred airway management strategy in patients suspected to have contracted COVID-19 requiring airway protection or invasive ventilation. However, this has re-ignited a debate which began during the Severe Acute Respiratory Syndrome (SARS) outbreak in the early 2000s around whether the benefit of paramedic-led intubation outweighs the risks to providers during a pandemic. The aim of this commentary is to revisit the evidence around paramedic-led intubation and provide a perspective on paramedic-led intubation during the COVID-19 pandemic. It is hoped this will stimulate further discussion around the benefits and risks of paramedic intubation in the setting of a pandemic.

https://doi.org/10.33151/ajp.17.806
PDF

References

Fouche P, Stein C, Simpson P, Carlson J, Doi S. Nonphysician out-of-hospital rapid sequence intubation success and adverse events: a systematic review and meta-analysis. Ann Emerg Med 2017;70:449-59. DOI: 10.1016/j.annemergmed.2017.03.026

Benger J, Kirby K, Black S, et al. Effect of a strategy of a supraglottic airway device vs tracheal intubation during out of hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomised clinical trial. J Am Med Assoc 2018;320:779-91. DOI: 10.1001/jama.2018.11597

Wang H, Schmicker R, Daya M, et al. Effect of a strategy of initial laryngeal tube insertion vs endotracheal intubation on 72-hour survival in adults with out-of-hospital cardiac arrest. ibid. 2018;320:769-78. DOI: 10.1001/jama.2018.7044

Bernard S, Nguyen V, Cameron P, et al. Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomised controlled trial. Ann Surg 2010;252:959-65. DOI: 10.1097/SLA.0b013e3181efc15f

Pepe P, Roppolo L, Fowler R. Prehospital endotracheal intubation: elemental or detrimental? Crit Care 2015;19:121. DOI: 10.1186/s13054-015-0808-x

Heschi S, Meadley B, Andrew E, et al. Efficacy of pre-hospital rapid sequence intubation in paediatric traumatic brain injury: a 9-year observational study. Injury 2018;49:916-20. DOI: 10.1016/j.injury.2018.02.013

Wang H, Balasubramani G, Cook L, Lave J, Yealy D. Out-of-hospital endotracheal intubation experience and patient outcomes. Ann Emerg Med 2010;55:527-37. DOI: 10.1016/j.annemergmed.2009.12.020

Bossers S, Schwarte L, Loer S, et al. Experience in prehospital endotracheal intubation significantly influences mortality of patients with severe traumatic brain injury: a systematic review and meta-analysis. PLoS One 2015;10:e0141034. DOI: 10.1371/journal.pone.0141034

Burton J, Baumann M, Maoz T, Bradshaw J, Lebrun J. Endotracheal intubation in a rural EMS state: procedure utilisation and impact of skills maintenance guidelines. Prehosp Emerg Care 2003;7:352-6. DOI: 10.1080/1090312090936554

Gillet B, Saloum D, Aghera A, Marshall J. Skill proficiency is predicted by intubation frequency of emergency medicine attending physicians. West J Emerg Med 2019;20:601-9. DOI: 10.5811/wetsjem.2019.6.42946

Gowens P, Aitken-Fell P, Broughton W, et al. Consensus statement: a framework for safe and effective intubation by paramedics. British Paramedic Journal 2018;3:23-7. DOI: 10.29045/14784726.2018.06.3.1.23

Fowler R, Guest C, Lapinsky S, et al. Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation. Am J Respir Crit Care Med 2004;169(11). DOI: 10.1164/rccm.200305-715OC

Verbreek R, Schwartz B, Burgess R. Should paramedics intubate patients with SARS-like symptoms? Can Med Assoc J 2003;169:299-300.

O’Neill R. Intubations should still be allowed with caution. ibid. 2003;169:299-300.

Ovens H. SARS is not unique. ibid. 2003;169:299-300.

Schabas R. Pre-hospital intubation and SARS. ibid. 2003;169:299-300.

Urszenyi, S. Discretion must reside with paramedics. ibid. 2003;169:299-300.

Shin H, Yoo H, Bae G, et al. Comparison of oropharyngeal leak pressure and clinical performance of LMA ProSeal and i-Gel in adults: meta-analysis and systematic review. J Int Med Res 2016;44:405-18. DOI: 10.1177/03000060515607386

Langhelle A, Sunde K, Wik L, Steen P. Airway pressure with chest compressions versus Heimlich manoeuvre in recently dead adults with complete airway obstruction. Resuscitation 2000;44:105-8. DOI: 10.1016/s0300-9572(00)00161-1

Zuo M, Huang Y, Ma W, et al. Expert recommendations for tracheal intubation in critically ill patients with novel coronavirus disease 2019. Chin Med Sci J 2020;0:10.

Brewster D, Chrimes N, Do T, et al. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J Aust 2020. Epub ahead of print. Available at: www.mja.com.au/journal/2020/consensus-statement-safe-airway-society-principles-airway-management-and-tracheal

Cook T, El-Boghdadly K, McGuire B, et al. Consensus guidelines for managing the airway in patients with COVID-19. Anaesthesia 2020. Epub ahead of print. Available at: www.ncbi.nlm.nih.gov/pubmed/32221970 DOI: 10.1111/anae.15054

Australia and New Zealand Intensive Care Society. COVID-19 Guidelines. Camberwell: ANZICS; 16 March 2020. Available at: http://cec.health.nsw.gov.au/__data/assets/pdf_file/0004/572512/ANZICS-COVID-19-Guidelines-Version-1.pdf