Feasibility of Prehospital Rapid Sequence Intubation in the Cabin of an AW169 Helicopter

Highlights

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Simulated and protocolized rapid sequence intubation (RSI) in an AW169 is as quick as simulated “outdoor” RSI.

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The time to secure endotracheal intubation (ETI) through an emergency front of neck access approach during a “can't intubate, can't ventilate” scenario did not differ between the “outdoor,” “aircraft,” and “helmets” scenario.

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Perceived distractions to in-cabin RSI, such as the wearing of a flight helmet with simulated engine noise and radio transmissions, had no impact on the time to ETI.

Abstract

Objective

Prehospital rapid sequence intubation (RSI) is an important aspect of prehospital care for helicopter emergency medical services (HEMS). This study examines the feasibility of in-aircraft (aircraft on the ground) RSI in different simulated settings.

Methods

Using an AW169 aircraft cabin simulator at Air Ambulance Kent Surrey Sussex, 3 clinical scenarios were devised. All required RSI in a “can intubate, can ventilate” (easy variant) and a “can't intubate, can't ventilate” scenario (difficult variant). Doctor-paramedic HEMS teams were video recorded, and elapsed times for prespecified end points were analyzed.

Results

Endotracheal intubation (ETI) was achieved fastest outside the simulator for the easy variant (median = 231 seconds, interquartile range = 28 seconds). Time to ETI was not significantly longer for in-aircraft RSI compared with RSI outside the aircraft, both in the easy (p = .14) and difficult variant (p = .50). Wearing helmets with noise distraction did not impact the time to intubation when compared with standard in-aircraft RSI, both in the easy (p = .28) and difficult variant (p = .24).

Conclusion

In-aircraft, on-the-ground RSI had no significant impact on the time to successful completion of ETI. Future studies should prospectively examine in-cabin RSI and explore the possibilities of in-flight RSI in civilian HEMS services.