Observational studyScandinavian journal of trauma, resuscitation and emergency medicine2022
Intubation success in prehospital emergency anaesthesia: a retrospective observational analysis of the Inter-Changeable Operator Model (ICOM).
Observational study in Scandinavian journal of trauma, resuscitation and emergency medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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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.
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.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 48 citations in OpenAlex.
- Safer prehospital anaesthesia: updated guidelines from the Association of Anaesthetists.Anaesthesia · 2026Guideline
- Inhaled methoxyflurane for fracture reduction in prehospital extremity trauma: an observational review of HEMS clinical practice.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Observational
- Intubation exposure associated with first-pass success - understanding practitioner-related characteristics in South African EMS.International journal of emergency medicine · 2026Article
- Article
- The impact of airway assistants on prehospital endotracheal intubations - a subgroup analysis of data from anaesthesiologist-staffed helicopter critical care teams.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Prehospital Postintubation Hypotension and Survival in Severe Traumatic Brain Injury.JAMA network open · 2025Observational
- Airway management analysis in the rescue environment of the emergency service Zug: a retrospective real-world evaluation.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Observational
- Video laryngoscopy versus direct laryngoscopy in a UK pre-hospital physician/critical care paramedic helicopter emergency medical service.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Performance characteristics and complications of an Inter-Changeable Operator Model for intubation in an Australian helicopter emergency medical service.Emergency medicine Australasia : EMA · 2025Observational
- Pre-hospital emergency anaesthesia in 2025: ten years on from the modification of induction regimes.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Review
- A protocol for the ERICA-ARREST feasibility study of Emergency Resuscitative Endovascular Balloon occlusion of the Aorta in Out-of-Hospital Cardiac Arrest.Resuscitation plus · 2024Article
- Implementation of a point-of-care ultrasound archiving system and governance framework in a UK physician-paramedic staffed helicopter emergency medical service.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Article
- Prehospital invasive arterial blood pressure monitoring in critically ill patients attended by a UK helicopter emergency medical service- a retrospective observational review of practice.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Observational
- Predictors of first-pass success intubations in the emergency departments in Germany: analysis of the German Airway Registry between 2015 and 2022.World journal of emergency medicine · 2024Article
- Critical hypertension in trauma patients following prehospital emergency anaesthesia: a multi-centre retrospective observational study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2023Observational
- Nine golden codes: improving the accuracy of Helicopter Emergency Medical Services (HEMS) dispatch-a retrospective, multi-organisational study in the East of England.Scandinavian journal of trauma, resuscitation and emergency medicine · 2023Observational
- Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2023Observational
- Severely injured patients: modern management strategies.EFORT open reviews · 2023Review
- Article
- The effect of a multi-faceted quality improvement program on paramedic intubation success in the critical care transport environment: a before-and-after study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2023Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPre hospital emergency anaesthesia (PHEA) is a complex procedure with significant risks. First-pass intubation success (FPS) is recommended as a quality indicator in pre hospital advanced airway management. Previous data demonstrating significantly lower FPS by non-physicians does not distinguish between non-physicians operating in isolation or within physician teams. In several UK HEMS, the role of the intubating provider is interchangeable between the physician and critical care paramedic-termed the Inter-Changeable Operator Model (ICOM). The objectives of this study were to compare first-pass intubation success rate between physicians and critical care paramedics (CCP) in a large regional, multi-organisational dataset of trauma PHEA patients, and to report the application of the ICOM.
methodsA retrospective observational study of consecutive trauma patients ≥ 16 years old who underwent PHEA at two different ICOM Helicopter Emergency Medical Services in the East of England, 2015-2020. Data are presented as number (percentage) and median [inter-quartile range]. Fisher's exact test was used to compare proportions, reported as odds ratio (OR (95% confidence interval, 95% CI)), p value. The study design complied with the STROBE (Strengthening The Reporting of Observational studies in Epidemiology) reporting guidelines.
resultsIn the study period, 13,654 patients were attended. 674 (4.9%) trauma patients ≥ 16 years old who underwent PHEA were included in the final analysis: the median age was 44 [28-63] years old, and 502 (74.5%) were male. There was no significant difference in the FPS rate between physicians and CCPs-90.2% and 87.4% respectively, OR 1.3 (95% CI 0.7-2.5), p = 0.38. The cumulative first, second, third, and fourth-pass intubation success rates were 89.6%, 98.7%, 99.7%, and 100%. Patients who had a physician-operated initial intubation attempt weighed more and had a higher heart rate, compared to those who had a CCP-operated initial attempt.
conclusionIn an ICOM setting, we demonstrated 100% intubation success in adult trauma patients undergoing PHEA. There was no significant difference in first-pass intubation success between physicians and CCPs.
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