Prehospital airway management

Coda Change

David Anderson describes the current state of play with airway management in the prehospital setting.

There are important differences between airway management in the prehospital environment and airway management in hospital. Prehospital intubation has been practiced for over 50 years and continues to evolve, with many techniques and procedures devised from prehospital use finding their way into ED and ICU practice. The main indications for prehospital intubation are cardiac arrest and severe TBI. 3 large studies show no evidence to support prehospital intubation in cardiac arrest and this practice should probably be reserved for specific cases. Prehospital RSI for TBI remains controversial as the evidence available to date is conflicting and isn’t high quality. While scene time if often commented on, there is no evidence available prehospital RSI increases time to CT or OR for patients with a severe TBI. There is no evidence that any one craft group is better at intubation than any other. In order to make prehospital airway management as safe as possible, innovations such as checklists, kit dumps and pre-drawn syringes are common. Many prehospital services invest much more heavily in the training and maintenance of airway skills than in-hospital specialties.

This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022.

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