A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa

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dc.contributor.authorWylie, Craig A
dc.contributor.authorAraie, Farzana
dc.contributor.authorHendrikse, Clint
dc.contributor.authorBurke, Jan
dc.contributor.authorJoubert, Ivan
dc.contributor.authorHardy, Anneli
dc.contributor.authorStassen, Willem
dc.date.accessioned2022-10-24T09:19:18Z
dc.date.available2022-10-24T09:19:18Z
dc.date.issued2022-07-16
dc.date.updated2022-07-17T03:16:04Z
dc.description.abstractIntroduction Prehospital advanced airway management, including endotracheal intubation (ETI), is one of the most commonly performed advanced life support skills. In South Africa, prehospital ETI is performed by non-physician prehospital providers. This practice has recently come under scrutiny due to lower first pass (FPS) and overall success rates, a high incidence of adverse events (AEs), and limited evidence regarding the impact of ETI on mortality. The aim of this study was to describe non-physician ETI in a South African national sample in terms of patient demographics, indications for intubation, means of intubation and success rates. A secondary aim was to determine what factors were predictive of first pass success. Methods This study was a retrospective chart review of prehospital ETIs performed by non-physician prehospital providers, between 01 January 2017 and 31 December 2017. Two national private Emergency Medical Services (EMS) and one provincial public EMS were sampled. Data were analysed descriptively and summarised. Logistic regression was performed to evaluate factors that affect the likelihood of FPS. Results A total of 926 cases were included. The majority of cases were adults (n = 781, 84.3%) and male (n = 553, 57.6%). The most common pathologies requiring emergency treatment were head injury, including traumatic brain injury (n = 328, 35.4%), followed by cardiac arrest (n = 204, 22.0%). The mean time on scene was 46 minutes (SD = 28.3). The most cited indication for intubation was decreased level of consciousness (n = 515, 55.6%), followed by cardiac arrest (n = 242, 26.9%) and ineffective ventilation (n = 96, 10.4%). Rapid sequence intubation (RSI, n = 344, 37.2%) was the most common approach. The FPS rate was 75.3%, with an overall success rate of 95.7%. Intubation failed in 33 (3.6%) patients. The need for ventilation was inversely associated with FPS (OR = 0.42, 95% CI: 0.20–0.88, p = 0.02); while deep sedation (OR = 0.56, 95% CI: 0.36–0.88, p = 0.13) and no drugs (OR = 0.47, 95% CI: 0.25–0.90, p = 0.02) compared to RSI was less likely to result in FPS. Increased scene time (OR = 0.99, 95% CI: 0.985–0.997, p < 0.01) was inversely associated FPS. Conclusion This is one of the first and largest studies evaluating prehospital ETI in Africa. In this sample of ground-based EMS non-physician ETI, we found success rates similar to those reported in the literature. More research is needed to determine AE rates and the impact of ETI on patient outcome. There is an urgent need to standardise prehospital ETI reporting in South Africa to facilitate future research.en_US
dc.identifier.apacitationWylie, C. A., Araie, F., Hendrikse, C., Burke, J., Joubert, I., Hardy, A., & Stassen, W. (2022). A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa. <i>BMC Emergency Medicine</i>, 22(1), 129. http://hdl.handle.net/11427/36870en_ZA
dc.identifier.chicagocitationWylie, Craig A, Farzana Araie, Clint Hendrikse, Jan Burke, Ivan Joubert, Anneli Hardy, and Willem Stassen "A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa." <i>BMC Emergency Medicine</i> 22, 1. (2022): 129. http://hdl.handle.net/11427/36870en_ZA
dc.identifier.citationWylie, C.A., Araie, F., Hendrikse, C., Burke, J., Joubert, I., Hardy, A. & Stassen, W. 2022. A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa. <i>BMC Emergency Medicine.</i> 22(1):129. http://hdl.handle.net/11427/36870en_ZA
dc.identifier.ris TY - Journal Article AU - Wylie, Craig A AU - Araie, Farzana AU - Hendrikse, Clint AU - Burke, Jan AU - Joubert, Ivan AU - Hardy, Anneli AU - Stassen, Willem AB - Introduction Prehospital advanced airway management, including endotracheal intubation (ETI), is one of the most commonly performed advanced life support skills. In South Africa, prehospital ETI is performed by non-physician prehospital providers. This practice has recently come under scrutiny due to lower first pass (FPS) and overall success rates, a high incidence of adverse events (AEs), and limited evidence regarding the impact of ETI on mortality. The aim of this study was to describe non-physician ETI in a South African national sample in terms of patient demographics, indications for intubation, means of intubation and success rates. A secondary aim was to determine what factors were predictive of first pass success. Methods This study was a retrospective chart review of prehospital ETIs performed by non-physician prehospital providers, between 01 January 2017 and 31 December 2017. Two national private Emergency Medical Services (EMS) and one provincial public EMS were sampled. Data were analysed descriptively and summarised. Logistic regression was performed to evaluate factors that affect the likelihood of FPS. Results A total of 926 cases were included. The majority of cases were adults (n = 781, 84.3%) and male (n = 553, 57.6%). The most common pathologies requiring emergency treatment were head injury, including traumatic brain injury (n = 328, 35.4%), followed by cardiac arrest (n = 204, 22.0%). The mean time on scene was 46 minutes (SD = 28.3). The most cited indication for intubation was decreased level of consciousness (n = 515, 55.6%), followed by cardiac arrest (n = 242, 26.9%) and ineffective ventilation (n = 96, 10.4%). Rapid sequence intubation (RSI, n = 344, 37.2%) was the most common approach. The FPS rate was 75.3%, with an overall success rate of 95.7%. Intubation failed in 33 (3.6%) patients. The need for ventilation was inversely associated with FPS (OR = 0.42, 95% CI: 0.20–0.88, p = 0.02); while deep sedation (OR = 0.56, 95% CI: 0.36–0.88, p = 0.13) and no drugs (OR = 0.47, 95% CI: 0.25–0.90, p = 0.02) compared to RSI was less likely to result in FPS. Increased scene time (OR = 0.99, 95% CI: 0.985–0.997, p < 0.01) was inversely associated FPS. Conclusion This is one of the first and largest studies evaluating prehospital ETI in Africa. In this sample of ground-based EMS non-physician ETI, we found success rates similar to those reported in the literature. More research is needed to determine AE rates and the impact of ETI on patient outcome. There is an urgent need to standardise prehospital ETI reporting in South Africa to facilitate future research. DA - 2022-07-16 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Emergency Medicine KW - Prehospital emergency care KW - Airway management KW - Endotracheal intubation KW - South Africa LK - https://open.uct.ac.za PY - 2022 T1 - A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa TI - A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa UR - http://hdl.handle.net/11427/36870 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12873-022-00688-4
dc.identifier.urihttp://hdl.handle.net/11427/36870
dc.identifier.vancouvercitationWylie CA, Araie F, Hendrikse C, Burke J, Joubert I, Hardy A, et al. A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa. BMC Emergency Medicine. 2022;22(1):129. http://hdl.handle.net/11427/36870.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentDivision of Emergency Medicineen_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceBMC Emergency Medicineen_US
dc.source.journalissue1en_US
dc.source.journalvolume22en_US
dc.source.pagination129en_US
dc.source.urihttps://bmcemergmed.biomedcentral.com/
dc.subjectPrehospital emergency careen_US
dc.subjectAirway managementen_US
dc.subjectEndotracheal intubationen_US
dc.subjectSouth Africaen_US
dc.titleA retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africaen_US
dc.typeJournal Articleen_US
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