Can experienced paramedics perform tracheal intubation at cardiac arrests? Five years experience of a regional air ambulance service in the UK.

Aims: Paramedic tracheal intubation has been reported to carry a high failure rate and morbidity. A comparison between doctor and paramedic-led intubation at out-of-hospital cardiac arrests (OHCA) was conducted to assess whether this finding was observed in our clinical practice.

Methods: Retrospective review of all medical OHCA attended by the Warwickshire and Northamptonshire Air Ambulance (WNAA) over a 64-month period. Cases were identified and divided into doctor-led or paramedic-led groups. Self-reported intubation failure rate, morbidity and clinical outcome were observed and compared. Paramedic exposure to tracheal intubation was assessed.

Results: 286 cases of medical OHCA were identified, 199 (69.6%) were doctor-led and 87 (30.4%) paramedic-led. Paramedic and doctor-led crews intubated an equivalent proportion of cases (Para-led 60.7% [37] vs. Dr-led 62.8% [98]; p=0.89) and no significant difference in failure rate was observed (Para-led 2.7% [1 case, 95% CI 0.0-7.9%] vs. Dr-led 3.1% [3 cases, 95% CI 0.0-6.5%]; p=1). No morbidity from failure-to-intubate was recorded, and equal rates of return of spontaneous circulation (ROSC) were observed (Para-led 20.7% [18] vs. Dr-led 20.6% [41]; p=0.89). Paramedics operating with the WNAA were found to have a higher exposure to tracheal intubation (WNAA 0.03 TT/shift vs. unselected paramedics 0.004 TT/shift).

Conclusions: Experienced paramedics regularly operating with physicians have a low tracheal intubation failure rate at OHCA, whether practicing independently or as part of a doctor-led team. This is likely due to increased and regular clinical exposure.