[National survey on out-of-hospital difficult intubation management]. / Enquête nationale sur la prise en charge de l'intubation difficile en médecine d'urgence préhospitalière.

OBJECTIVES: Difficult intubation rate is higher in the prehospital setting than in the operating room. Goal of this survey was to assess compliance of the French prehospital mobile emergency unit (Smur) to the recent French guidelines for the difficult airway management. STUDY DESIGN: National phone survey. METHODS: A phone questionnaire was proposed to one senior emergency physician of all 380 French Smur. Seven questions were asked about intubation devices used, availability of a written difficult intubation algorithm and intubation training of the Smur's physicians. RESULTS: Guidelines of the recent French consensus conference on difficult intubation are only partly followed by the Smur. Only 60% of the Smur perform systematic rapid intubation sequence, plastic laryngoscope blades are used by more than 50% of the Smur and less than 50% of the Smur have a written difficult intubation management algorithm available. The Gum elastic Bougie is available in 58% of the Smur and the intubating laryngeal mask airway in 71%, whereas initial formation for difficult intubation devices used is provided to the emergency physicians in only 58% of the Smur. CONCLUSION: This survey shows that the French guidelines for the difficult airway management are only partially followed by the French Smur. An effort should be made for a larger diffusion of these guidelines towards the emergency physicians working in the Smur.

Invasive arterial blood pressure monitoring in an out-of-hospital setting: an observational study.

BACKGROUND: Non-invasive arterial blood pressure measurement is often inaccurate in emergency unstable patients. A study was undertaken to assess the feasibility of out-of-hospital intra-arterial catheterisation in haemodynamically unstable patients and to evaluate the correlation between invasive and non-invasive arterial pressure values. METHODS: In this prospective 2-year observational study conducted by mobile emergency medical units, the success rate of arterial catheterisation was calculated and blood pressure values measured invasively and non-invasively after successful catheterisation were compared. RESULTS: 94 patients were included. The success rate for catheterisation (44 radial access, 50 femoral access) was 86% (95% CI 79% to 93%). Bias and precision in invasive versus non-invasive comparisons were -0.1, 38 mm Hg for systolic pressure and 4.2, 27 mm Hg for diastolic pressure. Values differed by more than 20 mm Hg in over 40% of patients. Invasive measurement led to 79 changes in vasoactive treatment in 51 patients. CONCLUSION: Emergency out-of-hospital invasive arterial blood pressure monitoring in haemodynamically unstable patients is highly feasible. Discrepancies between invasive and non-invasive measurements are common and highlight the value of early out-of-hospital monitoring.