The staff of FinnHEMS base in Vantaa, Finland, has developed a new, safer method for intubation. A research group at Helsinki University Hospital conducted a study investigating the effects of the implementation of a new intubation protocol on the success rate of intubation. Results of the study, funded also by FinnHEMS Research and Development Unit, proved to be the best in the world.
The most common advanced procedures performed by physician-staffed EMS units are anesthesia and intubation for securing the airway of an unconscious or injured patient. All over the world intubation is performed similarly by inserting a plastic intubation tube into the patient’s trachea with the help of a laryngoscope.
The staff of Vantaa HEMS unit decided to test a new method of intubation by combining two devices: a video laryngoscope was routinely combined with a bougie, normally used for difficult intubations. The whole process and non-technical aspects were standardized as far as possible. This two-instrument method was studied in Vantaa’s physician-staffed HEMS unit during a study period of almost two years with associate professor Jouni Nurmi leading the research group.
The new method was investigated on 543 patients with a control group of 238 patients. The results were remarkable: with the new protocol, first-attempt success rate was 98,2 %, compared to 85,7 % with the traditional method. The results for the control group are aligned with internationally reported results for physician-staffed EMS units. The success rate achieved with the new method is the best reported result in studies worldwide with intubation succeeding on the first attempt almost every time.
Intubation is a common but challenging procedure. The risk of complications increases with each attempt, which is why first pass success is important. In the worst-case scenario, complications can even result in death. Based on this research, it would be recommended to always perform prehospital intubation with this new method. However, not all EMS units have the necessary equipment yet.
During the study period hundreds of paramedics were trained in the area of Vantaa HEMS with the process being developed further. The procedure was also filmed, and the video has been viewed on YouTube over 35 000 times.
The study was published in Anaesthesia: http://onlinelibrary.wiley.com/doi/10.1111/anae.14182/full
Video in Youtube (in Finnish): https://youtu.be/nDD-6BFEzyA