Survey of Out-of-hospital Emergency Intubations in the French Prehospital Medical System: A Multicenter Study,☆☆,

Presented at the Second International Congress on Intubation and Upper Airway, Bordeaux, France, June 1997.
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Abstract

Study Objective: To determine the clinical characteristics of endotracheal intubation in the French emergency prehospital medical system and compare these data with those of other systems. Methods: This study was performed in Ile de France (Paris Region) in mobile ICUs staffed by physicians. This prospective, descriptive study involved completion of a questionnaire by the operator just after endotracheal intubation was performed. Results: Six hundred eighty-five (99.1%) of 691 consecutive prehospital intubations were performed successfully in the field. The orotracheal route was used in 96.0%, and no surgical approaches such as cricothyroidotomy were used. Mechanical complications occurred in 84 patients, at a rate of 15.9% for nonarrest patients and 8.1% for arrest patients. A wide variety of sedation protocols were used. Difficult intubations (10.8%) were comparable in incidence to the number seen in US emergency departments, not US prehospital systems. By the same token, intubation success rates (99.1%) were comparable to US EDs and much higher than US prehospital results. Conclusion: The characteristics of French prehospital airway management differ significantly from those of other countries. These differences may be explained by differences in approach to prehospital management rather than differences of skill. [Adnet F, Jouriles NJ, Le Toumelin P, Hennequin B, Taillandier C, Rayeh F, Couvreur J, Nougière B, Nadiras P, Ladka A, Fleury M: Survey of out-of-hospital emergency intubations in the French prehospital medical system: A multicenter study. Ann Emerg Med October 1998;32:454-460.]

Section snippets

INTRODUCTION

Emergency endotracheal intubation (ETI) is a lifesaving technique with which all emergency physicians should be familiar.1 Although ETI in Anglo-Saxon prehospital EMS system has been studied,2, 3, 4, 5, 6, 7, 8, 9, 10, 11 there are few studies of field ETI performed by the French prehospital emergency medical system.12 The French prehospital emergency medical system, called SAMU (Service d’Aide Médicale Urgente), differs conceptually from Anglo-Saxon prehospital systems. For example, in France,

MATERIALS AND METHODS

In France, management of out-of-hospital emergencies is the responsibility of the SAMU. France is divided into 95 regional SAMUs organized as follows: 1 dispatching center with switchboard operators and 2 dispatching physicians situated in a major hospital covering a given medical region. SAMU is the equivalent of the Anglo-Saxon command center for the region. Universal access to SAMU is by telephone number 15, the national emergency call for help. Switchboard operators, available 24 hours a

RESULTS

During the 6 months of the study, 691 patients had out-of-hospital ETI. Questionnaires were completed for all patients, and no patient was excluded. The mean age (±SD) was 51.4±20.2 years, and the sex ratio (male:female) was 1.97.

Six hundred eighty-five patients (99.1%) were intubated successfully in the field. The median (25th; 75th percentiles) number of attempts for successful intubation was 1 (1;2) attempt. The rate of success was 68% for the first attempt and 21% for 2 attempts. The number

DISCUSSION

ETI is the definitive procedure for airway control and respiratory management. Over the past 20 years, several studies have evaluated prehospital ETI by paramedic providers in Anglo-Saxon advanced life support systems.2, 3, 4, 5, 6, 7, 8, 9, 10, 11 However, there are few detailed evaluations of ETI in the French prehospital medical system (SAMU), which relies on physician providers.12 Our study compares the performance of SAMU providers with published studies from other prehospital systems.

The

Acknowledgements

The authors acknowledge Nancy Flanagan for her grammatical correction of this manuscript.

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    From the SAMU 93, CHU Avicenne, University Paris XIII; 93009 Bobigny Cedex* ; SMUR Lariboisiere, CHU Lariboisire, Paris ; Department of Emergency Medicine, CWRU/MetroHealth Center, Cleveland, OH§ ; SMUR Delafontaine, Hôpital Delafontaine, 93205 Saint Denis ; SMUR Aulnays, CHR Ballanger, 93600 Aulnays ; SAMU 86, CHR Poitiers, 86000 Poitiers# ; SMUR Argenteuil, Hôpital d’Argenteuil, 95107 Argenteuil** ; SAMU 91, CHR Corbeil, 91100 Corbeil ; SMUR Montfermeil, CHI Montfermeil, 93370 Montfermeil‡‡ ; and SAMU Melun, CHR Melun, 77000 Melun,§§ France.

    ☆☆

    Reprint no. 47/1/92760

    Address for reprints: Frédéric Adnet, MD, PhD, Service d’Aide Médicale Urgente (SAMU 93), CHU Avicenne, 125, rue de Stalingrad, 93009 Bobigny Cedex, France, +33-1-48-96-44-00, Telecopy: +33-1-48-96-44-45, E-mail [email protected]

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