Introduction: This study aimed to identify factors associated with successful endotracheal intubation (ETI) by a multisite emergency medical services (EMS) agency.

Methods: We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth). We analyzed patient and EMS factors affecting ETI.

Results: During 12,527 emergent ambulance responses, 200 intubation attempts were made in 150 patients. Intubation was successful in 113 (75%). A crew with paramedics was more than three times as likely to achieve successful intubation as a paramedic/emergency medical technician-Basic crew (odds ratio [OR], 3.30; P=.03). A small tube (£7.0 inches) was associated with a more than 4-fold increased likelihood of successful ETI compared with a large tube (³7.5 inches) (OR, 4.25; P=.01). After adjustment for these features, compared with little or no view of the glottis, a partial or entire view of the glottis was associated with a nearly 13-fold (OR, 12.98; P=.001) and a nearly 40-fold (OR, 39.78; P<.001) increased likelihood of successful intubation, respectively.

Conclusion: Successful ETI was more likely to be accomplished when a paramedic was partnered with another paramedic, when some or all of the glottis was visible and when a smaller endotracheal tube was used. [West J Emerg Med. 2016;17(5)640-647.]

Introduction: American Heart Association (AHA) guidelines recommend cardiopulmonary resuscitation (CPR) chest compressions 1.5 to 2 inches (3.75-5 cm) deep at 100 to 120 per minute. Recent studies demonstrated that manual CPR by emergency medical services (EMS) personnel is substandard. We hypothesized that transport CPR quality is significantly worse than on-scene CPR quality.

Methods: We analyzed adult patients receiving on-scene and transport chest compressions from nine EMS sites across two Midwestern states from May 2008 to July 2010. Two periods were analyzed: before and after visual feedback. CPR data were collected and exported with the Zoll M series monitor and a sternally placed accelerometer measuring chest compression rate and depth. We compared compression data with 2010 AHA guidelines and Zoll RescueNet Code Review software. CPR depth and rate were “above (deep),” “in,” or “below (shallow)” the target range according to AHA guidelines. We paired on-scene and transport data for each patient; paired proportions were compared with the nonparametric Wilcoxon signed rank test.

Results: In the pre-feedback period, we analyzed 105 of 140 paired cases (75.0%); in the post-feedback period, 35 of 140 paired cases (25.0%) were analyzed. The proportion of correct depths during on-scene compressions (median, 41.9%; interquartile range [IQR], 16.1-73.1) was higher compared to the paired transport proportion (median, 8.7%; IQR 2.7-48.9). Proportions of on-scene median correct rates and transport median correct depths did not improve in the post-feedback period.

Conclusion: Transport chest compressions are significantly worse than on-scene compressions. Implementation of visual real-time feedback did not affect performance. [West J Emerg Med. 2016;17(5)634-639.]