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David Lockey – One of the best experts on this subject based on the ideXlab platform.

  • Best practice advice on pre-hospital emergency anaesthesia & Advanced Airway Management
    Scandinavian journal of trauma resuscitation and emergency medicine, 2019
    Co-Authors: Kate Crewdson, David Lockey, Wolfgang Voelckel, Peter Temesvari, Hans Morten Lossius
    Abstract:

    Effective and timely Airway Management is a priority for sick and injured patients. The benefit and conduct of pre-hospital emergency anaesthesia (PHEA) and Advanced Airway Management remains controversial but there are a proportion of critically ill and injured patients who require urgent Advanced Airway Management prior to hospital arrival. This document provides current best practice advice for the provision of PHEA and Advanced Airway Management. This best practice advice was developed from EHAC Medical Working Group enforced by pre-hospital critical care experts. The group used a nominal group technique to establish the current best practice for the provision of PHEA and Advanced Airway Management. The group met on three separate occasions to discuss and develop the guideline. All members of the working party were able to access and edit the guideline online. This EHAC best practice advice covers all areas of PHEA and Advanced Airway Management and provides up to date evidence of current best practice. PHEA and Advanced Airway Management are complex interventions that should be delivered by appropriately trained personnel using a well-rehearsed approach and standardised equipment. Where Advanced Airway interventions cannot be delivered, careful attention should be given to applying basic Airway interventions and ensuring their effectiveness at all times.

  • best practice advice on pre hospital emergency anaesthesia Advanced Airway Management
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2019
    Co-Authors: Kate Crewdson, David Lockey, Wolfgang Voelckel, Peter Temesvari, Hans Morten Lossius
    Abstract:

    Effective and timely Airway Management is a priority for sick and injured patients. The benefit and conduct of pre-hospital emergency anaesthesia (PHEA) and Advanced Airway Management remains controversial but there are a proportion of critically ill and injured patients who require urgent Advanced Airway Management prior to hospital arrival. This document provides current best practice advice for the provision of PHEA and Advanced Airway Management. This best practice advice was developed from EHAC Medical Working Group enforced by pre-hospital critical care experts. The group used a nominal group technique to establish the current best practice for the provision of PHEA and Advanced Airway Management. The group met on three separate occasions to discuss and develop the guideline. All members of the working party were able to access and edit the guideline online. This EHAC best practice advice covers all areas of PHEA and Advanced Airway Management and provides up to date evidence of current best practice. PHEA and Advanced Airway Management are complex interventions that should be delivered by appropriately trained personnel using a well-rehearsed approach and standardised equipment. Where Advanced Airway interventions cannot be delivered, careful attention should be given to applying basic Airway interventions and ensuring their effectiveness at all times.

  • Best practice advice on pre-hospital emergency anaesthesia & Advanced Airway Management
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2019
    Co-Authors: Kate Crewdson, David Lockey, Wolfgang Voelckel, Peter Temesvari, Hans Morten Lossius
    Abstract:

    Background Effective and timely Airway Management is a priority for sick and injured patients. The benefit and conduct of pre-hospital emergency anaesthesia (PHEA) and Advanced Airway Management remains controversial but there are a proportion of critically ill and injured patients who require urgent Advanced Airway Management prior to hospital arrival. This document provides current best practice advice for the provision of PHEA and Advanced Airway Management. Method This best practice advice was developed from EHAC Medical Working Group enforced by pre-hospital critical care experts. The group used a nominal group technique to establish the current best practice for the provision of PHEA and Advanced Airway Management. The group met on three separate occasions to discuss and develop the guideline. All members of the working party were able to access and edit the guideline online. Results This EHAC best practice advice covers all areas of PHEA and Advanced Airway Management and provides up to date evidence of current best practice. Conclusion PHEA and Advanced Airway Management are complex interventions that should be delivered by appropriately trained personnel using a well-rehearsed approach and standardised equipment. Where Advanced Airway interventions cannot be delivered, careful attention should be given to applying basic Airway interventions and ensuring their effectiveness at all times.

Hans Morten Lossius – One of the best experts on this subject based on the ideXlab platform.

  • Checklists in pre-hospital Advanced Airway Management.
    Acta anaesthesiologica Scandinavica, 2019
    Co-Authors: Cecilia Klingberg, Hans Morten Lossius, Daniel Kornhall, Dan Gryth, Andreas J. Krüger, Mikael Gellerfors
    Abstract:

    Background In pre-hospital care, pre-intubation checklists (PICL) are widely implemented as a safety measure and guidelines support their use. However, the true value of PICL among experienced Airway providers is unknown. This study aims to explore possible benefits and disadvantages of PICL in the pre-hospital setting. Methods We performed a subgroup analysis of a prospective, observational, multicentre study on pre-hospital Advanced Airway Management in the Nordic countries between May 2015 and November 2016. The original trial was designed to investigate the success rates of pre-hospital tracheal intubations and the incidence of complications. Our study limited inclusion to drug assisted intubations performed by anaesthesiologists. Intubation success rates and complication rates were plotted against checklist use. Results We analyzed 588 pre-hospital intubations for medical and traumatic emergencies. Overall, checklists were used in 60.5% of instances. Applying checklists was associated with increased success at first and second intubation attempts. There was no significant difference in the overall success rates (99.4% and 99.1%). Oesophageal misplacement was more common in the No-PICL group (2.2% vs 0.3%) but otherwise the incidence of Airway related complications did not differ between the groups. Scene time was significantly shorter in the No-PICL group (23.6 vs 27.5 minutes). Conclusion In this retrospective study, checklist use correlated with fewer attempts at intubation when securing the Airway. Despite this, we found no association between checklist use and the overall TI success rate or the incidence of serious adverse events. Scene times were shorter without PICL.

  • Best practice advice on pre-hospital emergency anaesthesia & Advanced Airway Management
    Scandinavian journal of trauma resuscitation and emergency medicine, 2019
    Co-Authors: Kate Crewdson, David Lockey, Wolfgang Voelckel, Peter Temesvari, Hans Morten Lossius
    Abstract:

    Effective and timely Airway Management is a priority for sick and injured patients. The benefit and conduct of pre-hospital emergency anaesthesia (PHEA) and Advanced Airway Management remains controversial but there are a proportion of critically ill and injured patients who require urgent Advanced Airway Management prior to hospital arrival. This document provides current best practice advice for the provision of PHEA and Advanced Airway Management. This best practice advice was developed from EHAC Medical Working Group enforced by pre-hospital critical care experts. The group used a nominal group technique to establish the current best practice for the provision of PHEA and Advanced Airway Management. The group met on three separate occasions to discuss and develop the guideline. All members of the working party were able to access and edit the guideline online. This EHAC best practice advice covers all areas of PHEA and Advanced Airway Management and provides up to date evidence of current best practice. PHEA and Advanced Airway Management are complex interventions that should be delivered by appropriately trained personnel using a well-rehearsed approach and standardised equipment. Where Advanced Airway interventions cannot be delivered, careful attention should be given to applying basic Airway interventions and ensuring their effectiveness at all times.

  • best practice advice on pre hospital emergency anaesthesia Advanced Airway Management
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2019
    Co-Authors: Kate Crewdson, David Lockey, Wolfgang Voelckel, Peter Temesvari, Hans Morten Lossius
    Abstract:

    Effective and timely Airway Management is a priority for sick and injured patients. The benefit and conduct of pre-hospital emergency anaesthesia (PHEA) and Advanced Airway Management remains controversial but there are a proportion of critically ill and injured patients who require urgent Advanced Airway Management prior to hospital arrival. This document provides current best practice advice for the provision of PHEA and Advanced Airway Management. This best practice advice was developed from EHAC Medical Working Group enforced by pre-hospital critical care experts. The group used a nominal group technique to establish the current best practice for the provision of PHEA and Advanced Airway Management. The group met on three separate occasions to discuss and develop the guideline. All members of the working party were able to access and edit the guideline online. This EHAC best practice advice covers all areas of PHEA and Advanced Airway Management and provides up to date evidence of current best practice. PHEA and Advanced Airway Management are complex interventions that should be delivered by appropriately trained personnel using a well-rehearsed approach and standardised equipment. Where Advanced Airway interventions cannot be delivered, careful attention should be given to applying basic Airway interventions and ensuring their effectiveness at all times.

Leif Rognås – One of the best experts on this subject based on the ideXlab platform.

  • Pre-hospital Advanced Airway Management by anaesthetist and nurse anaesthetist critical care teams: a prospective observational study of 2028 pre-hospital tracheal intubations.
    British journal of anaesthesia, 2018
    Co-Authors: Mikael Gellerfors, Leif Rognås, Andreas J. Krüger, Espen Fevang, Anders Bäckman, Søren Mikkelsen, Jouni Nurmi, Erik Sandström, Gabriel Skallsjö, Christer Svensén
    Abstract:

    Abstract Background Pre-hospital tracheal intubation success and complication rates vary considerably among provider categories. The purpose of this study was to estimate the success and complication rates of pre-hospital tracheal intubation performed by physician anaesthetist or nurse anaesthetist pre-hospital critical care teams. Methods Data were prospectively collected from critical care teams staffed with a physician anaesthetist or a nurse anaesthetist according to the Utstein template for pre-hospital Advanced Airway Management. The patients served by six ambulance helicopters and six rapid response vehicles in Denmark, Finland, Norway, and Sweden from May 2015 to November 2016 were included. Results The critical care teams attended to 32 007 patients; 2028 (6.3%) required pre-hospital tracheal intubation. The overall success rate of pre-hospital tracheal intubation was 98.7% with a median intubation time of 25 s and an on-scene time of 25 min. The majority (67.0%) of the patients’ tracheas were intubated by providers who had performed >2500 tracheal intubations. The success rate of tracheal intubation on the first attempt was 84.5%, and 95.9% of intubations were completed after two attempts. Complications related to pre-hospital tracheal intubation were recorded in 10.9% of the patients. Intubations after rapid sequence induction had a higher success rate compared with intubations without rapid sequence induction (99.4% vs 98.1%; P =0.02). Physicians had a higher tracheal intubation success rate than nurses (99.0% vs 97.6%; P =0.03). Conclusions When performed by experienced physician anaesthetists and nurse anaesthetists, pre-hospital tracheal intubation was completed rapidly with high success rates and a low incidence of complications. Clinical trial number NCT 02450071.

  • Anaesthesiologist-provided pre-hospital Advanced Airway Management in children
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2015
    Co-Authors: Mona Tarpgaard, Troels Martin Hansen, Leif Rognås
    Abstract:

    Background Pre-hospital Advanced Airway Management has been named one of the top-five research priorities in physician-provided pre-hospital critical care [1]. Few studies have been made on paediatric pre-hospital Advanced Airway Management. The aim of this study was to investigate first-pass success rates and complications related to pre-hospital Advanced Airway Management in patients younger than 16 years of age treated by prehospital critical care teams in the Central Denmark Region (1.3 million inhabitants).

  • anaesthetist provided pre hospital Advanced Airway Management in children a descriptive study
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2015
    Co-Authors: Mona Tarpgaard, Troels Martin Hansen, Leif Rognås
    Abstract:

    Pre-hospital Advanced Airway Management has been named one of the top-five research priorities in physician-provided pre-hospital critical care. Few studies have been made on paediatric pre-hospital Advanced Airway Management. The aim of this study was to investigate pre-hospital endotracheal intubation success rate in children, first-pass success rates and complications related to pre-hospital Advanced Airway Management in patients younger than 16 years of age treated by pre-hospital critical care teams in the Central Denmark Region (1.3 million inhabitants). A prospective descriptive study based on data collected from eight anaesthetist-staffed pre-hospital critical care teams between February 1st 2011 and November 1st 2012. Primary endpoints were 1) pre-hospital endotracheal intubation success rate in children 2) pre-hospital endotracheal intubation first-pass success rate in children and 3) complications related to prehospital Advanced Airway Management in children. The pre-hospital critical care anaesthetists attempted endotracheal intubation in 25 children, 13 of which were less than 2 years old. In one patient, a neonate (600 g birth weight), endotracheal intubation failed. The patient was managed by uneventful bag-mask ventilation. All other 24 children had their tracheas successfully intubated by the pre-hospital critical care anaesthetists resulting in a pre-hospital endotracheal intubation success rate of 96 %. Overall first pass success-rate was 75 %. In the group of patients younger than 2 years old, first pass success-rate was 54 %. The total rate of Airway Management related complications such as vomiting, aspiration, accidental intubation of the oesophagus or right main stem bronchus, hypoxia (oxygen saturation < 90 %) or bradycardia (according to age) was 20 % in children younger than 16 years of age and 38 % in children younger than 2 years of age. No deaths, cardiac arrests or severe bradycardia (heart rate <60) occurred in relation to pre-hospital Advanced Airway Management. Compared with the total population of patients receiving pre-hospital Advanced Airway Management in our system, the overall success rate following pre-hospital endotracheal intubations in children is acceptable but the first-pass success rate is low. The complication rates in the paediatric population are higher than in our pre-hospital Advanced Airway Management patient population as a whole. This illustrates that young children may represent a substantial pre-hospital Airway Management challenge even for experienced pre-hospital critical care anaesthetists. This may influence future training and quality insurance initiatives in paediatric pre-hospital Advanced Airway Management.

Henry E. Wang – One of the best experts on this subject based on the ideXlab platform.

  • Endotracheal intubation during out-of-hospital cardiac arrest: New insights from recent clinical trials.
    Journal of the American College of Emergency Physicians open, 2019
    Co-Authors: Henry E. Wang, Jonathan Benger
    Abstract:

    Airway Management is an important intervention during resuscitation of out-of-hospital cardiac arrest (OHCA). Endotracheal intubation is commonly used by emergency medical services paramedics in the Advanced Airway Management of OHCA, but numerous studies question its safety and effectiveness. Furthermore, there is now increasing use of supraglottic Airway devices. In this review, we provide an overview of 3 recent randomized clinical trials of Advanced Airway Management (Pragmatic Airway Resuscitation Trial [PART], AirwayS-2, and Cardiac Arrest Airway Management [CAAM]) and highlight new information that is available to guide OHCA Airway Management practices.

  • Advanced Airway Management success rates in a national cohort of emergency medical services agencies.
    Resuscitation, 2019
    Co-Authors: Tracy Nwanne, John P. Donnelly, Jeffrey L. Jarvis, Dustin Barton, Henry E. Wang
    Abstract:

    Abstract Objective Despite its important role in care of the critically ill, there have been few large-scale descriptions of the epidemiology of Emergency Medical Services (EMS) Advanced Airway Management (AAM) and the variations in care with different patient subsets. We sought to characterize AAM performance in a national cohort of EMS agencies. Methods We used data from ESO Solutions, Inc., a national EMS electronic health record system. We analyzed EMS emergency patient encounters during 2011–2015 with attempted AAM. We categorized AAM techniques as conventional endotracheal intubation (cETI), neuromuscular blockade assisted intubation (NMBA-ETI), supraglottic Airway (SGA), and cricothyroidotomy (needle and open). Determination of successful AAM was based on EMS provider report. We analyzed the data using descriptive statistics, determining the incidence and clinical characteristics of AAM cases. We determined success rates for each AAM technique, stratifying by the subsets cardiac arrest, medical non-arrest, trauma, and pediatrics (age ≤12 years). Results AAM occurred in 57,209 patients. Overall AAM success was 89.1% (95% CI: 88.8–89.3%) across all patients and techniques. Intubation success rates varied by technique; cETI (n = 38,004; 76.9%, 95% CI: 76.5–77.3%), NMBA-ETI (n = 6768; 89.7%, 88.9–90.4%). SGAs were used both for initial (n = 9461, 90.1% success, 95% CI: 89.5–90.7%) and rescue (n = 5994, 87.3% success, 95% CI: 86.4–88.1%) AAM. Cricothyroidotomy success rates were low: initial cricothyroidotomy (n = 202, 17.3% success, 95% CI: 12.4–23.3%), rescue cricothyroidotomy (n = 85, 52.9% success, 95% CI: 41.8–88%). AAM success rates varied by patient subset: cardiac arrest (n = 35,782; 91.7%, 95% CI: 91.4–92.0), medical non-arrest (n = 17,086; 84.7%, 84.2–85.2%); trauma (n = 4341; 84.3%, 83.1–85.3%); pediatric (n = 1223; 73.7%, 71.2–76.2%). Conclusion AAM success rates varied by Airway technique and patient subset. In this national cohort, these results offer perspectives of EMS AAM practices.

  • Defining the plateau point: When are further attempts futile in out-of-hospital Advanced Airway Management?
    Resuscitation, 2018
    Co-Authors: Jeffrey L. Jarvis, Dustin Barton, Henry E. Wang
    Abstract:

    Abstract Background We sought to characterize the number of attempts required to achieve Advanced Airway Management (AAM) success. Methods Using 4 years of data from a national EMS electronic health record system, we examined the following subsets of attempted AAM: 1) cardiac arrest intubation (CA-ETI), 2) non-arrest medical intubation (MED-ETI), 3) non-arrest trauma intubation (TRA-ETI), 4) rapid-sequence intubation (RSI), 5) sedation-assisted ETI (SAI), and 6) supraglottic Airway (SGA). We determined the first pass and overall success rates, as well as the point of additional attempt futility (“plateau point”). Results Among 57,209 patients there were 64,291 AAM. CA-ETI performance was: first-pass success (FPS) 71.4% (95% CI: 70.9–71.9%), 4 attempts to reach 91.5% (91.2–91.9%) success plateau. MED-ETI performance was: FPS 66.0% (95% CI: 65.1–67.0%), 3 attempts to reach 79.2% (78.4–80.0%) success plateau. TRA-ETI performance was: FPS 61.6% (95% CI: 59.3–63.9%), 3 attempts to reach 75.8% (73.7–77.8%) success plateau. RSI performance was: FPS 76.1% (95% CI: 75.1–77.1%), 5 attempts to reach 95.8% (95.3–96.2%) success plateau. SAI performance was: FPS 66.9% (95% CI: 65.1–68.6%), 3 attempts to 85.3% (83.9–86.6%) success plateau. SGA performance was: FPS 88.7% (95% CI: 88.0–89.3%), 5 attempts to reach 92.8% (92.3–93.4%) success plateau. Conclusion Multiple attempts are often needed to accomplish successful AAM. The number of attempts needed to accomplish AAM varies with AAM technique. These results may guide AAM practices.

Stephen Jm Sollid – One of the best experts on this subject based on the ideXlab platform.

  • Standardised data reporting from pre-hospital Advanced Airway Management – a nominal group technique update of the Utstein-style Airway template.
    Scandinavian journal of trauma resuscitation and emergency medicine, 2018
    Co-Authors: Geir Arne Sunde, David Lockey, Jon Kenneth Heltne, Mikael Gellerfors, Andreas J. Krüger, Alexandre Kottmann, Mårten Sandberg, Stephen Jm Sollid
    Abstract:

    Background Pre-hospital Advanced Airway Management with oxygenation and ventilation may be vital for managing critically ill or injured patients. To improve pre-hospital critical care and develop evidence-based guidelines, research on standardised high-quality data is important. We aimed to identify which Airway data were most important to report today and to revise and update a previously reported Utstein-style Airway Management dataset.

  • a consensus based template for uniform reporting of data from pre hospital Advanced Airway Management
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2009
    Co-Authors: Stephen Jm Sollid, Hans Morten Lossius, David Lockey
    Abstract:

    Background Advanced Airway Management is a critical intervention that can harm the patient if performed poorly. The available literature on this subject is rich, but it is difficult to interpret due to a huge variability and poor definitions. Several initiatives from large organisations concerned with Airway Management have recently propagated the need for guidelines and standards in pre-hospital Airway Management. Following the path of other initiatives to establish templates for uniform data reporting, like the many Utstein-style templates, we initiated and carried out a structured consensus process with international experts to establish a set of core data points to be documented and reported in cases of Advanced pre-hospital Airway Management.

  • Pre-hospital Advanced Airway Management by anaesthesiologists: Is there still room for improvement?
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2008
    Co-Authors: Stephen Jm Sollid, Jon Kenneth Heltne, Eldar Søreide, Hans Morten Lossius
    Abstract:

    Background Endotracheal intubation is an important part of pre-hospital Advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital Advanced Airway Management. Method Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Results Of the 17 available respondents, most (88%) felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of Airway Management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had Airway back-up equipment in their service, but 29% were not familiar with all the equipment. Conclusion The majority of anaesthesiologists working as HEMS physicians view pre-hospital Advanced Airway Management as a high-risk procedure. Relevant Airway Management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.