Guideline on Treatment of Patients with Severe and Multiple ... - AWMF

S3 <strong>Guideline</strong> on Treatment of Patients with Severe and Multiple Injuries
56%, 81% and 91%). The specific success rates of endotracheal intubation by paramedics, nurses
and emergency physicians were not broken down further. The results of this study [101] show
that the cumulative success rate of endotracheal intubation in a paramedic system is markedly
below that of emergency physician systems staffed solely by anesthesiologists, whose rate is 97-
100% [48, 92, 94]. However, the administration of drugs, as they are used during a rapid
sequence induction (including muscle relaxants), helps to facilitate endotracheal intubation in
patients without cardiac arrest and thus leads to a markedly higher intubation success. Both are
frequently vital for survival in an emergency situation. According to the above-cited study
results, alternative methods should be considered for securing an airway after more than 3
intubation attempts [4, 65]. Although fiberoptic procedures are only available in isolated cases in
the prehospital phase, fiberoptic intubation must be available in-hospital. In all common
guidelines and recommendations on emergency airway securing, (awake) fiberoptic intubation is
considered a possible procedure for securing an airway if there is appropriate experience and
appropriate environmental conditions [33, 46, 49, 59].
In contrast, emergency cricothyroidotomy is simply the last resort in a “cannot ventilate - cannot
intubate” situation to secure ventilation and oxygenation in an emergency. In national and
international recommendations and guidelines, emergency cricothyroidotomy has a firm place in
prehospital and hospital phases and is indicated if alternative methods for securing an airway and
bag-valve-mask ventilation are not successful [9, 46, 49, 70].
Prehospital – Airway management, ventilation and emergency anesthesia 27