"Having solid evidence for what method is most effective allows us to offer the best care possible to patients in these life-or-death situations," said William Bozeman, M.D., lead author, from Wake Forest University Baptist Medical Center.
The study compared the combination of sedative and paralytic drugs to relax the airway and the patient, with the use of a sedative alone. Previous studies had compared drug protocols, but looked only at whether insertion of the breathing tube was successful. The current study went a step further and measured and recorded the condition of the airway. Even if the insertion, or intubation, is successful, there can be damage to the airway or other complications that can result in disability or death.
For each patient, the crew recorded the airway conditions, such as whether the vocal cords were visible, whether the patient was relaxed and whether the intubation was successful. The study involved 49 patients who were transported over a year's time by two helicopters in the same system. For six months, one helicoptor's patients received the sedative alone and the other helicoptor's patients got the combination of a sedative and a paralytic drug. For the next six months, the protocols were switched.
"We found that using the sedative alone resulted in lower intubation success and a more difficult intubation," said Bozeman. The likelihood of successful intubaton was 3.7 times higher with the combination of medications, which is called rapid-sequence intubation. "In some systems, using basic oxygen and techniques to keep the airway open -- and not attempting intubation -- is the safest option for patients. In other systems with highly skilled and experienced providers who work under close medical oversight, rapid-sequence intubation may be the best choice," said Bozeman.
MEDICA.de; Source: Wake Forest University Baptist Medical Center