A Continuous Quality Improvement Airway Program Results In Sustained Increases In Intubation Success


David J. Olvera, NRP, FP-C, CMTE, David F. E. Stuhlmiller, MD, Allen Wolfe, RN, Charles F. Swearingen, BS, NREMT-P, FP-C, Troy Pennington, DO, Daniel P. Davis, MD


Introduction: Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance.

Objectives: The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success.

Methods: The Helicopter Advanced Resuscitation Training (HeART) program was implemented across 160 bases in 2015. The HeART program includes a novel conceptual framework based on thorough understanding of physiology, critical thinking using a novel algorithm, difficult airway predictive tools, training in the optimal use of specific airway techniques and devices, and integrated performance improvement efforts to address opportunities for improvement. The C-MAC video/direct laryngoscope and high-fidelity human patient simulation laboratories were implemented during the study period. Chi-square test for trend was used to evaluate for improvements in airway management and RSI success (overall intubation success, first-attempt success, first-attempt success without desaturation) over the 25-month study period following HeART implementation.

Results: A total of 5,132 patients underwent RSI during the study period. Improvements in first-attempt intubation success (85% to 95%, p < 0.01) and first-attempt success without desaturation (84% to 94%, p < 0.01) were observed. Over-all intubation success increased from 95% to 99% over the study period, but the trend was not statistically significant (p = 0.311).

Conclusions: An integrated advanced airway management program was successful in improving RSI intubation performance in a large air medical company.

Keywords: prehospital intubation; videoscopic intubation; continuous quality improvement; critical care transport; air medical transport

Click below to read the full study published by Prehospital Emergency Care, Volume 2, 2018 – Issue 5