Evidence map›Paper›PMID 28196506›Full record

SynthesisCritical care (London, England)2017

The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis.

K Crewdson, D J Lockey, J Røislien, H M Lossius, M Rehn

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
55citing papers in PubMed, 7 pooled it
15.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

55 citing papers in PubMed, 7 syntheses or guidelines pooled it, 141 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. A systematic review of the timing of intubation in patients with traumatic brain injury: pre-hospital versus in-hospital intubation.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023
    Pooled it
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  5. Efficacy of tracheal tube introducers and stylets for endotracheal intubation in the prehospital setting: a systematic review and meta-analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022
    Pooled it
  6. Pooled it
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  8. Trial
  9. Trial
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  12. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 2 countries.

K CrewdsonLondon Air Ambulance, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK. katecrewdson@gmail.com.
D J LockeyLondon Air Ambulance, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK.
J RøislienDepartment of Health Studies, University of Stavanger, Kjell Arholmsgate 41, N-4036, Stavanger, Norway.
H M LossiusThe Norwegian Air Ambulance Foundation, Holterveien 24, N-1441, Drøbak, Norway.
M RehnLondon Air Ambulance, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK.
University of Stavanger · NONorth Bristol NHS Trust · GBRoyal London Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPre-hospital basic airway interventions can be ineffective at providing adequate oxygenation and ventilation in some severely ill or injured patients, and advanced airway interventions are then required. Controversy exists regarding the level of provider required to perform successful pre-hospital intubation. A previous meta-analysis reported pre-hospital intubation success rates of 0.849 for non-physicians versus 0.991 for physicians. The evidence base on the topic has expanded significantly in the last 10 years. This study systematically reviewed recent literature and presents comprehensive data on intubation success rates.

methodsA systematic search of MEDLINE and EMBASE was performed using PRISMA methodology to identify articles on pre-hospital tracheal intubation published between 2006 and 2016. Overall success rates were estimated using random effects meta-analysis. The relationship between intubation success rate and provider type was assessed in weighted linear regression analysis.

resultsOf the 1838 identified studies, 38 met the study inclusion criteria. Intubation was performed by non-physicians in half of the studies and by physicians in the other half. The crude median (range) reported overall success rate was 0.969 (0.616-1.000). In random effects meta-analysis, the estimated overall intubation success rate was 0.953 (0.938-0.965). The crude median (range) reported intubation success rates for non-physicians were 0.917 (0.616-1.000) and, for physicians, were 0.988 (0.781-1.000) (p = 0.003). DISCUSSION: The reported overall success rate of pre-hospital intubation has improved, yet there is still a significant difference between non-physician and physician providers. The finding that less-experienced personnel perform less well is not unexpected, but since there is considerable evidence that poorly performed intubation carries a significant risk of morbidity and mortality careful consideration should be given to the training and experience required to deliver this intervention safely.

Indexed as

Emergency Medical ServicesHealth PersonnelHumansIntubation, IntratrachealWorkforceAirway managementIntubationPre-hospital emergency careSystemic literature review

Identifiers

PMID28196506
PMCPMC5309978
OpenAlexW2587974101

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.