The effect of etomidate on airway management practices of an air medical transport service

Objective

The authors studied the effect of introducing etomidate on the airway management practices of their air transport crew and specifically considered the need for paralytic agents during rapid-sequence intubation.

Methods

A prospective observational review of the transport records for all patients aged greater than 10 years who required intubation transported by the air medical crew before (PRE) and after (POST) the introduction of etomidate into the authors' rapid-sequence induction protocol was conducted. Data were collected, including the method of intubation, indications for intubation, and complications from the procedure. The following outcomes were measured: the method used for intubation (nasotracheal or orotracheal), oral intubation success rate, number of attempts for oral intubation, need for paralytic agents, and complications with the procedure.

Results

Comparing the PRE and POST periods, nasotracheal intubation was performed in 27 of 70 (38.6%) versus 33 of 71 (46.4%; p = 0.237997). The overall success rate for intubation in the PRE period was 67 of 70 (95.7%), with 95.3% of orotracheal intubations being successful. In the POST period, the overall success rate was 65 of 71 (91.5%), with 94.7% of orotracheal intubations being successful. Complication rates were similar between the groups. Etomidate reduced the use of paralytic agents from 46 of 62 (74.6%) of patients receiving midazolam to 10 of 22 (45.5%) intubated with etomidate (p = 0.02).

Conclusions

Etomidate did not appear to have an impact on the selection of intubation methods by the air medical transport crew. Etomidate significantly reduced the need for administration of paralytic agents used in an RSI.