Safety and Quality of Care

Rescuer experience with out-of-hospital emergency intubation is often associated with improved patient survival

Experienced surgeons routinely perform high volumes of a particular surgery all the time. But what about those who provide out-of-hospital emergency care, such as first responders, rescuers, and paramedics? How does their experience, particularly with airway insertion (endotracheal intubation), impact patient survival? A new study finds that the more experience a rescuer has with this complex medical procedure, the more survival improves for patients with cardiac arrest and for those with medical conditions who do not arrest. However, rescuer experience is not linked to trauma patients without cardiac arrest.

Henry E. Wang, M.D., M.S., of the University of Alabama at Birmingham, and colleagues analyzed survival data for Pennsylvania hospital patients who received out-of-hospital airway insertion by rescuers during 2003 to 2005, and correlated it with the experience levels of the rescuers. Low experience was considered 1 to 10 intubations during 2000 to 2005. Medium experience was 11 to 25 intubations. High-level experience was 26 to 50 procedures, with a very high-level classification reserved for those rescuers performing more than 50 intubations during the time period.

A total of 4,846 rescuers performed tracheal intubations on 33,117 patients during 2003 and 2005 and on 62,586 patients during 2000 to 2005. Among 21,753 cardiac arrests, the adjusted odds of survival were highest when rescuers with very high experience performed their intubations. The same was true for 8,162 medical nonarrest patients. The survival of the 3,202 patients who suffered trauma without cardiac arrest was not associated with the experience level of the rescuer. However, there were improved outcomes for this group when air medical emergency medical services provided treatment. The study was supported in part by the Agency for Healthcare Research and Quality (HS13628).

See "Out-of-hospital endotracheal intubation experience and patient outcomes," by Dr. Wang, G.K. Balasubramani, Ph.D., Lawrence J. Cook, Ph.D., and others in the June 2010 Annals of Emergency Medicine 55(6), pp. 527-537.e6.

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