A Positive Wang Intubation Study


For those of you who do not follow EMS research closely, for the last 10 years Henry Wang has dared to question the effectiveness of paramedic intubation.  While this has made him one of the least popular names mentioned over adult beverages at EMS conferences, most people admit that what he’s found is true.  Paramedics get less training than other intubators, , it frequently requires multiple attempts for us to intubate someone, chest compressions get interrupted far to long during intubation, and procedural experience with intubation is associated with better outcomes.

Flipping through the abstracts from the 2012 NAEMSP Scientific Assembly, I glanced over the words “Wang” and “intubation.”  Oh no, I thought, how bad is this one going to be? I was shocked to read:

Conclusions. In this prospective multicenter North American OHCA series, ETI was associated with improved ROSC, 24-hour survival, and survival to hospital discharge over SGA. ETI was not associated with secondary complications. ETI may be preferable to SGA in OHCA airway management.
This and the other abstracts can be found here.
                Before anyone starts toasting laryngoscope blades, there are a few things to keep in mind.  First, this is only an abstract and not a published study.  We only have the highlights.  Second, Tom Rea is another author on the study, which means his intubating outliers in Seattle were probably included.  Third, results from this large, multi-center trial may not apply to individual services.
               On EMSEducast Episode 131, intubation was one of the topics discussed with Dr. John Studnek, who does research with the Carolinas Medical Center.  He found that a single intubation attempt for cardiac arrest was associated with lower survival in the greater Charlotte area.  Paramedics there only have the opportunity to intubate 1-2 times a year, and access to live OR practice is not available.  Based on this data, ET tubes are now considered a back-up to the King Airway.
               The best airway for cardiac arrest depends on the makeup of paramedics in that community.  If we are to be taken seriously as a profession, we need to critically evaluate airway management based on patient outcomes.   The choice of procedure should be supported with data from that service.  A few services, like Seattle, have proven that intubation is effective.  Other services, like in Charlotte, have demonstrated that a King Airway is better.
                 I don’t want to see intubation go away, but I get excited about organizations  implementing protocols based on this level of evidence.  We need more people like Henry Wang and John Studnek, and even more people to listen to them.

Comments

  1. Bob,
    As you know I agree with this type of treatment. Where I disagree is the need for protocols to be implemented for this type of care. Deparments should be hiring and training medics to have this critical thinking knowledge. Even with protocols dictating methods, times, etc… Medics still continue to not use critical thinking. I am not sure what it will take But when systems are still having medics that cannot understand the reasoning behind when, where, and why a procedure should/should not be performed, then someone is missing the mark.

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