Recently, Dr. Jeff Jarvis was published in the Annals of Emergency Medicine for a paper regarding a clinical bundle he developed to reduce complications during intubation. Specifically, his paper was to help reduce hypoxia in out-of-hospital intubation attempts. However, the pearls can be used by anyone managing the airway of a patient.
Intubations are potentially very dangerous and we have talked about the HOp killers in the past on Podcast #57 when we discussed the RTI approach to intubation. Often, we run across the HOp killer of hypoxia and many fail to properly manage this leading to peri- and post-intubation complications such as cardiac arrest. After some recent major trials (PART and AIRWAYS-2), there has been controversy regarding intubations in the field and in general. Tyler Christifulli, Jeff Jarvis, and Michael Perlmutter interviewed the lead authors of both trials in a recent FOAMfrat podcast. Check out that podcast for a great review of those papers and the concerns posed.
However, Jeff Jarvis got his turn with some colleagues to post another major paper. We brought him on to discuss the paper and what makes his EMS agency different from many across the country. The most important difference is that his agency is truly high performance. What does "high performance" mean? It's more than just the success rate of their intubations, but how they actually monitor their success. They are in a "Goldilocks" situation where they have enough resources to accurately measure their intubations and the outcomes without the overwhelming amount of paramedics to lose track of this data and keep it manageable. Long story short: if you do not have actual data of your agency's success rates, you are most likely not high performing.
Using a before and after study, the paper found that peri-intubation hypoxia was reduced from 44.2% to 3.5% using this approach. The exact protocol implemented, the actual paper, and an accompanying presentation are all available below. Check this out while you are listening to the podcast to learn even more of the fine details we discuss.
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