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Master Thesis

Taux d'échec de la première tentative d’intubation trachéale dans la prise en charge de l’arrêt cardio-respiratoire en extra-hospitalier

Abstract : Introduction: endotracheal intubation (ETI) is commonly used for the airway management during out-of-hospital cardiac arrest (OHCA). The advanced procedure of ETI provides a definitive airway protection. However, ETI is a complex procedure and exposes to many complications that can lead to resuscitation failure. Several recent international studies have criticized the dominant role of ETI in OHCA. Optimal airway management in OHCA is unclear. We decided to study the failure rate of the first attempt of ETI in OHCA and the variables associated with this failure. We also looked for the rate of difficult intubation and adverse events in patients with out-of-hospital cardiac arrest. Methods: we performed an ancillary study based on the results of the SMURIDS PROJECT study, a prospective, multicentre and observational study during 17 months and involved 10 prehospital emergency medical services in metropolitan France. Patients aged 15 years or older with OHCA were included in the study. Patients who received therapy to facilitate the ETI were excluded. After each ETI, the operator was asked to complete a data collection form with information on operator, patient, and environmental characteristics during the intubation. The main objective was to evaluate the failure rate of the first intubation attempt in the OHCA. Results: 848 patients with OHCA were analysed. 291 tracheal intubations failed on the first attempt (34,3%; 95% CI = 31,1-37,5). 128 ETI were considered difficult (15,1%; 95% CI = 12,7-17,5) with an ETI defined as difficult for an IDS score > 5. Multivariate analysis isolated 6 variables associated with failure of the first ETI attempt: ENT abnormality, the inter-incisal space less than two fingerbreadths, male gender, the presence of vomiting, the practice of ETI without interrupting chest compressions, and an operator with experience of 50 or fewer previous ETI. The incidence of adverse events was 14,7%. Conclusion: the rate of failure of the first attempt at ETI in the OHCA patient was high. We isolated six variables associated with an excess risk of this failure. Most of the risk factors could only be identified at the time they occurred. The rate of complications increased with the number of attempts.
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https://dumas.ccsd.cnrs.fr/dumas-03202298
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Submitted on : Monday, April 19, 2021 - 4:55:43 PM
Last modification on : Thursday, May 13, 2021 - 3:18:15 AM
Long-term archiving on: : Tuesday, July 20, 2021 - 7:20:02 PM

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Georges Tazi. Taux d'échec de la première tentative d’intubation trachéale dans la prise en charge de l’arrêt cardio-respiratoire en extra-hospitalier. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03202298⟩

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