Analysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy

Abstract Background Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, success, especially first-pass success (FPS) these situations is imperative. Methods We conducted a prospective observational study on all 12 helicopter medical service (HEMS) bases Swiss Air Rescue, between February 15, 2018, 14, 2019. All 428 patients whom out-of-hospital advanced was performed by HEMS crew were included. The C-MAC video laryngoscope used as primary device for tracheal intubation. Intubation procedures recorded precise time points to verify necessary each attempt overall procedure until successful videos further analysed problems complications during an independent reviewer. Additionally, questionnaire about procedure, basic characteristics patient, circumstances, environmental factors, provider’s level experience filled out. Main outcome measures FPS intubation, rate, time, laryngoscopy. Results rate 87.6% 98.6%. Success rates, subjective difficulty not associated providers’ expertise management. In undergoing CPR 84.8%, trauma 86.4% non-trauma 93.3%. with difficult characteristics, facial trauma/burns or obesity ranges 87 89%. Performing indoors inside ambulance resulted significantly higher 91.1% compared outdoor locations ( p < 0.001). Direct solar irradiation screen, fogging lens, blood camera impaired FPS. Several issues improvements use laryngoscopy setting quality control identified. Conclusion Airway using Macintosh blade group operators mixed showed high rates success. Video recording intubations may improve education control.