video analysis of prehospital emergency intubations

Conditions: Intubation; Prehospital; Videolaryngoscopy

Summary: the investigators' knowledge about pre-hospital emergency intubations is still limited. various factors such as the average and the normal range of intubation time are still unknown. since its launch rega videotapes all intubation attempts with the c-mac videolaryngoscope. the investigators prospectively analysed all routinely recorded intubation videos during one year performed by the rega crews. the investigators analysed different parameters such as first pass success rate and the time to successfully intubate alongside with others. the goal was to find out more about this difficult procedure, about the problems which regularly occur and on what should be put particular emphasis during training.

pre-hospital emergency intubations are especially hazardous. the incidence of unanticipated difficult airways is higher (9,3 % of prehospital intubations are more difficult than anticipated). the first attempt intubation success rates are lower and the rate of complications compared to in-hospital emergency intubations is higher. there is conflicting evidence if first attempt intubation success rate in prehospital intubations differs between intubations performed by videolaryngoscopy and direct laryngoscopy. on the other hand in pre-hospital airway management, the use of a c-mac videolaryngoscope improved the visualization of glottic structures significantly. the c-mac has recently launched a new version, which allows videotaping of intubations. rega decided to videotape all intubation attempts for legal purposes and quality control. these videos are stored at a rega-based secure central database. the investigators knowledge there is only one video-enhanced retrospective analyses of a limited number of videolaryngoscopic pre-hospital intubations. so far, there is no video-enhanced prospective analysis of first attempt intubation success rates or of the time necessary for successful intubation with videolaryngoscopes in the pre-hospital setting available. therefore, the investigators intend to determine the exact first attempt intubation success rate and the time necessary to successfully intubate, alongside with parameters such as the cormack/lehane grade, blade position (macintosh vs miller) and others (e.g. difficulties during intubation) in the pre-hospital physician-staffed hems-setting. the investigators' goal is to learn more about what is actually happening during prehospital intubations and what type of difficulties may occur. the investigators therefore prospectively analysed all routinely recorded intubation videos (using the built-in camera of the c-mac videolaryngoscope) during one year performed by the rega crews. these videos show real life intubations through the video function included in the device, only the image from the tip of the laryngoscopy blade inside the patient's mouth is recorded. the operating physicians additionally provided anonymous information about intubation management for each video after returning to the helicopter base

Eligibility criteria:
inclusion criteria: • all videos routinely taken from intubations performed during 1 year at the swiss air rescue (rega) at all 13 helicopter bases exclusion criteria: * patients who were intubated primarily using other devices without a camera * intubations that were not recorded (missing data).