Paramedic Intubation Experience Is Associated With Successful Tube Placement but Not Cardiac Arrest Survival - 29/08/17
, Janet E. Bray, PhD a, d, e, Karen Smith, PhD a, b, c, Stephen Bernard, MBBS MD a, b, d, Lahn Straney, PhD a, Resmi Nair, PhD b, Judith Finn, PhD a, c, eAbstract |
Study objective |
Paramedic experience with intubation may be an important factor in skill performance and patient outcomes. Our objective is to examine the association between previous intubation experience and successful intubation. In a subcohort of out-of-hospital cardiac arrest cases, we also measure the association between patient survival and previous paramedic intubation experience.
Methods |
We analyzed data from Ambulance Victoria electronic patient care records and the Victorian Ambulance Cardiac Arrest Registry for January 1, 2008, to September 26, 2014. For each patient case, we defined intubation experience as the number of intubations attempted by each paramedic in the previous 3 years. Using logistic regression, we estimated the association between intubation experience and (1) successful intubation and (2) first-pass success. In the out-of-hospital cardiac arrest cohort, we determined the association between previous intubation experience and patient survival.
Results |
During the 6.7-year study period, 769 paramedics attempted intubation in 14,857 patients. Paramedics typically performed 3 intubations per year (interquartile range 1 to 6). Most intubations were successful (95%), including 80% on the first attempt. Previous intubation experience was associated with intubation success (odds ratio 1.04; 95% confidence interval 1.03 to 1.05) and intubation first-pass success (odds ratio 1.02; 95% confidence interval 1.01 to 1.03). In the out-of-hospital cardiac arrest subcohort (n=9,751), paramedic intubation experience was not associated with patient survival.
Conclusion |
Paramedics in this Australian cohort performed few intubations. Previous experience was associated with successful intubation. Among out-of-hospital cardiac arrest patients for whom intubation was attempted, previous paramedic intubation experience was not associated with patient survival.
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| Please see page 383 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Henry E. Wang, MD, MS |
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| Author contributions: KD conceived the study, analyzed the data, and drafted the article. KD, KS, and RN extracted, linked, and managed the data. LS provided statistical advice on study design. All authors contributed substantially to article revision. KD takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| 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 as per ICMJE conflict of interest guidelines (see www.icmje.org/). Dr. Dyson is supported by a National Health and Medical Research Council (NHMRC) Public Health Postgraduate Research Scholarship (ID 1075456) and a scholarship funded through the NHMRC Australian Resuscitation Outcomes Consortium (Aus-ROC) Centre of Research Excellence (CRE; ID 1029983; www.ausroc.org.au). Dr. Bray receives an early career researcher fellowship from the NHMRC and the Heart Foundation (ID 1069985/100136). Drs. Bray, Straney, and Finn receive salary support from the NHMRC Aus-ROC CRE. Dr. Finn receives salary support from St John Ambulance Western Australia. Drs. Dyson, Smith, Bernard, and Nair are employed by Ambulance Victoria. |
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Vol 70 - N° 3
P. 382 - septembre 2017 Retour au numéro
Article précédent
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