Successful Implementation of an Etomidate Facilitated Endotracheal Intubation Protocol in an Urban Ground Transport Ambulance System

Purpose: There is an extensive body of literature describing the shortcomings of prehospital endotracheal intubation (ETI). The study purpose is to elucidate the patient, paramedic and system attributes contributing to successful implementation of etomidate facilitated ETI.

Methods: The ambulance call report database was searched using the criteria of orotracheal intubation and etomidate use. Paramedic identifiers were used to track the number of ETI attempts. The service database was used to collect data regarding frequency with which individual medics in the service performed ETI. Data regarding change in the patient's condition and outcomes were also recorded.

Results: Our paramedic service consisted of 100 paramedics. The median years of service were 10 (range: 2 to 28); median number of hours worked weekly was 3 (range: 1 to 4). Our paramedics had extensive experience with ETI; median number of 4 attempts (range: 0 to 52). There was a statistically significant difference in overall success rate between the 24 month period prior to inclusion of etomidate in the prehospital pharmacopeia and post etomidate implementation phase (85.7 vs. 90.4%; P<.05). There was no statistical difference in success rate between the groups intubated with and without etomidate in the post-implementation phase (84.6% vs. 90.8%; P=.154).

Conclusions: The addition of etomidate did not significantly affect our rate of successful intubation, nor did we experience an increase in adverse effects. Patients requiring sedation are by definition difficult intubations and the absence of a significant difference in success rate or complication rate suggests a beneficial effect of etomidate.