Neuromuscular Blockade Improves Intubation
Success
Eight Hour Training Course
This study conducted in San Diego County,
trained approximately ¾ of practicing paramedics in rapid sequence
intubation (RIS) using neuromuscular blocking agents with an 8 hour course and
certification.
The target population was adult trauma
victims with severe traumatic head injury (TBI), a GCS of 8 or less and
transportation time of greater than 10 minutes. The medication regime consisted
of midazolam for sedation, succinycholine for paralysis, rocuronium for
paralysis maintenance and morphine for hypertensive stress response. A total of
249 patients meet inclusion criteria and 123 patients were entered into the
trial. The indications for RSI included clenched jaw, presence of gag reflex
and a combative patient. The total procedure was performed on 114 patients with
success in 113 (99%) with ET intubation in 96 patients and Combitube placement
in 17 patients.
Performing the procedure added 14 minutes to
on-scene time and reduced the number of RSI performed by airmedical crews. The
99% success rate shows improvement over the general 84% success rate of ET
intubations alone. The findings may not be generalizable to other districts due
to the experience and already aggressive airway management protocols in place
before the trial. For more information, see:
Davis DP, Ochs M, Hoyt DB, et al. (2003).
Paramedic-administerred neuromuscular blockade improves prehospital intubation
success in severely head-injured patients. The Journal of Trauma, Injury,
Infection and Crticial Care, 55, 713-719. [review prepared by Andrew Reimer
BSN RN] |
