Cited by 163Airway Management and Intubation TechniquesRespiratory Support and MechanismsTrauma and Emergency Care Studies

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Emergency intubation for acutely ill and injured patients

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Lecky, Fiona, Bryden, Daniele, Little, Rod, Tong, Nam, Moulton, Chris·2008·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd001429.pub2PMC PMC7045728

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Abstract

BACKGROUND: Emergency intubation has been widely advocated as a life saving procedure in severe acute illness and injury associated with real or potential compromises to the patient's airway and ventilation. However, some initial data have suggested a lack of observed benefit. OBJECTIVES: To determine in acutely ill and injured patients who have real or anticipated problems in maintaining an adequate airway whether emergency endotracheal intubation, as opposed to other airway management techniques, improves the outcome in terms of survival, degree of disability at discharge or length of stay and complications occurring in hospital. SEARCH STRATEGY: We searched the Cochrane Injuries Group Specialised Register (December 2006), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4), MEDLINE (1950 to November 2006), EMBASE (1980 to week 50, December 2006), National Research Register (Issue 4, 2006), CINAHL (1980 to December 2006), BIDS (to December 2006) and ICNARC (to December 2006). We also examined reference lists of articles for relevant material and contacted experts in the field. Non-English language publications were searched for and examined. SELECTION CRITERIA: All randomised (RCTs) or controlled clinical trials involving the emergency use of endotracheal intubation in the injured or acutely ill patient were examined. DATA COLLECTION AND ANALYSIS: The full texts of 452 studies were reviewed independently by two authors using a standard form. Where the review authors felt a study may be relevant for inclusion in the final review or disagreed, the authors examined the study and a collective decision was made regarding its inclusion or exclusion from the review. The results were not combined in a meta-analysis due to the heterogeneity of patients, practitioners and alternatives to intubation that were used. MAIN RESULTS: We identified three eligible RCTs carried out in urban environments. Two trials involved adults with non-traumatic out-of-hospital cardiac arrest. One of these trials found a non-significant survival disadvantage in patients randomised to receive a physician-operated intubation versus a combi-tube (RR 0.44, 95% CI 0.09 to 1.99). The second trial detected a non-significant survival disadvantage in patients randomised to paramedic intubation versus an oesophageal gastric airway (RR 0.86, 95% CI 0.39 to 1.90). The third included study was a trial of children requiring airway intervention in the prehospital environment. The results indicated no difference in survival (OR 0.82, 95% CI 0.61 to 1.11) or neurologic outcome (OR 0.87, 95% CI 0.62 to 1.22) between paramedic intubation versus bag-valve-mask ventilation and later hospital intubation by emergency physicians; however, only 42% of the children randomised to paramedic endotracheal intubation actually received it. AUTHORS' CONCLUSIONS: The efficacy of emergency intubation as currently practised has not been rigorously studied. The skill level of the operator may be key in determining efficacy. In non-traumatic cardiac arrest, it is unlikely that intubation carries the same life saving benefit as early defibrillation and bystander cardiopulmonary resuscitation (CPR). In trauma and paediatric patients, the current evidence base provides no imperative to extend the practice of prehospital intubation in urban systems. It would be ethical and pertinent to initiate a large, high quality randomised trial comparing the efficacy of competently practised emergency intubation with basic bag-valve-mask manoeuvres (BVM) in urban adult out-of-hospital non-traumatic cardiac arrest.

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Authors: Lecky, F., Bryden, D., Little, R., Tong, N., & Moulton, C.
Affiliations: Salford Royal Hospital (GB)
Royal Hallamshire Hospital (GB)
University of Manchester (GB)
Queen Elizabeth Hospital (GB)
Royal Bolton Hospital (GB)
ORCID: Lecky, Fiona
Moulton, Chris
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2008-04-23
Volume: 2009
Issue: 1
Pages: CD001429-CD001429
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd001429.pub2
PMC: PMC7045728
OpenAlex: W1581108483
Cited by: 163
References: 71
Citations by year: 2026: 2 · 2025: 3 · 2024: 7 · 2022: 3 · 2021: 6 · 2020: 4 · 2019: 2 · 2018: 11 · 2017: 7 · 2016: 9 · 2015: 17 · 2014: 6 · 2013: 12 · 2012: 15
FWCI: 3.53
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
Keywords: emergency intubation, airway management, acute illness, trauma patients, out-of-hospital cardiac arrest, survival, length of hospital stay, complications, critically ill adults, older adults, prehospital care, emergency department care, esophageal intubation
MeSH terms: Acute Disease, Adult, Airway Obstruction, Child, Emergencies, Emergency Medical Technicians, Emergency Medicine, Heart Arrest, Humans, Intubation, Intratracheal, Wounds and Injuries, Randomized Controlled Trials as Topic

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Emergency intubation for acutely ill and injured patients

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