University of Oulu

Sami Länkimäki, Michael Spalding, Antti Saari, Seppo Alahuhta, Procedural Sedation Intubation in a Paramedic-Staffed Helicopter Emergency Medical System in Northern Finland, Air Medical Journal, Volume 40, Issue 6, 2021, Pages 385-389, ISSN 1067-991X,

Procedural sedation intubation in a paramedic-staffed helicopter emergency medical system in northern Finland

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Author: Länkimäki, Sami1,2; Spalding, Michael2; Saari, Antti3;
Organizations: 1Emergency Medical Service, Department of Emergency Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
2Department of Anaesthesiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
3Centre for Prehospital Emergency Care, Lapland Hospital District, Rovaniemi, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
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Language: English
Published: Elsevier, 2021
Publish Date: 2022-01-26


Objective: Airway management to ensure sufficient gas exchange is of major importance in emergency care. Prehospital endotracheal intubation (ETI) by paramedics is a widely debated method to ensure a patent airway. ETI is performed with procedural sedation in comatose patients because of the regulation. The use of medications increases the rate of successful airway management compared with nonmedication ETI and may also improve outcomes in patients with traumatic brain injury. In the absence of an operative emergency physician and with long distances, paramedic-induced airway management may increase the survival of patients in selected scenarios. A paramedic-staffed helicopter emergency medical system in Northern Finland operates in a rural area without an emergency physician and paralytic medications and treats critically ill patients using basic or advanced life support ground units. The aim of this study was to evaluate the success rates of ETI performed by a small, appropriately trained, and experienced group of 8 nurse paramedics in an out-of-hospital setting.

Methods: The inclusion criterion for the study was an attempted intubation in patients with medical or traumatic indication for airway management by nurse paramedic.

Results: Fifty-one patients were treated with ETI. The first-pass success rate was 72.5%, the second-pass success rate was 94.1%, and the overall success rate was 100% within 4 attempts. The median on-scene time was 54 minutes, and there were no signs of aspiration during laryngoscopy or after successful ETI. The primary mortality rate was 11.7%.

Conclusion: The use of a rigid standard operating procedure for paramedic rapid sequence induction, paralytics, a video laryngoscope, and a gum elastic bougie might positively affect the ETI first-pass success rate. A follow-up study after these future modifications is needed. This small study suggests that intubation might be 1 option for airway management by an experienced nonanesthesiologist in Lapland.

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Series: Air medical journal
ISSN: 1067-991X
ISSN-E: 1532-6497
ISSN-L: 1067-991X
Volume: 40
Issue: 6
Pages: 385 - 389
DOI: 10.1016/j.amj.2021.08.012
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © 2021 The Authors. Published by Elsevier Inc. on behalf of Air Medical Journal Associates. This is an open access article under the CC BY license (