Low Survival after Emergency Drug-Free Intubation

The study, conducted by researchers at Royal London Hospital (UK), was published in the July 21, 2001, issue of the British Medical Journal.

It is common practice in the United Kingdom for paramedics to perform tracheal intubation on trauma patients without administering muscle relaxants or anesthetic drugs. The intervention was introduced to improve outcomes after cardiac arrest, but recently its effectiveness has been questioned. Attempted intubation without drugs has potential risks, such as an increase in intracranial pressure, vomiting, and esophageal intubation. In fact, anecdotal evidence indicates that patients intubated without drugs have a poor prognosis. Even when drugs are used to facilitate intubation, failed intubation rates are high.

The researchers reviewed retrospectively the database of a helicopter emergency medical service targeted at trauma patients. During a six-year period, 1,623 patients were intubated out of hospital. The researchers excluded 143 who were not trauma patients and 988 who were intubated with drugs. Of the remaining 492, 217 were intubated by paramedics and 275 by doctors. Survival data were not available for six patients. Of the remaining 486 patients, only one survived. According to the researchers, this can probably be explained by the fact that a patient must be deeply unconscious to allow easy passage of a tracheal tube without drugs, indicating a high likelihood of death. They advise that the use of intubation without drugs should be given further scrutiny.