Endotracheal intubation during cardiac arrest by critical care paramedics: a service evaluation of success rates following structured education.

Abstract

Background: Endotracheal intubation is an important pre-hospital intervention in critically ill patients. However, it can be a challenging skill, and previous studies have highlighted varying success rates. The European Resuscitation Council (ERC) have set a clear target of a greater than 95% success rate within two attempts, for all clinicians who provide endotracheal intubation during cardiac arrest. This service evaluation looks to explore the impact of training and education on the intubation performance of critical care paramedics.

Methods: Retrospective data was collected from a single service over a six year period, from April 2019 to December 2024. During that time period, a number of educational or organisational interventions were introduced, with the aim of improving endotracheal intubation success rates. Data from all intubation attempts for patients in cardiac arrest by critical-care paramedics working with the Devon Air Ambulance Trust were recorded. The primary outcome was the rate of success of endotracheal intubation within two attempts. Secondary outcomes included the rate of first-pass success and the number of patients who had a failed first intubation attempt and did not receive a subsequent attempt. A Chi-squared statistical test was used to judge the significance of change between data from the years 2019 and 2024.

Results: 390 patients were included and reviewed. Between 2019 and 2024, success rates within two attempts improved by 7.9% points (χ² = 4.205, p = 0.040), while first-pass success rates improved by 18.4% points (χ² = 7.125, p = 0.0076). The success rate within two attempts at endotracheal intubation in 2024 was 97.7%. Over the whole time period, intubation was successful within two attempts in 94.6% (n = 369) of patients, while the first-pass success rate was 82.6% (n = 322). Of the 68 patients who had an unsuccessful first intubation attempt, 19.1% (n = 13) did not receive a second attempt.

Conclusions: Implementation of a training and education programme was associated with a significant improvement in endotracheal intubation success rates within the service. With dedicated training, critical care paramedics demonstrate safe and effective endotracheal intubation for patients in out-of-hospital cardiac arrest, meeting the ERC recommendations of a greater than 95% success rate within two attempts at intubation.