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23/09/2018

ISR par des non médecins: Oui possible

Prehospital Rapid Sequence Intubation by Intensive Care Flight Paramedics.

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Vaste débat. En France une intubation ne peut être réalisé que par un médecin ou un IADE. Ce n'est pas le cas dans d'autres pays, notamment anglo-saxonss mais pas que, où ce geste est pratiqué également par des techniciens paramédicaux spécifiquement formés notamment les paramedics. On rappelle que sous ce terme se cache des techniciens dont la formation centrée sur l'urgence dure près de 3 ans. Ce travail montre que, dans un environnement de traumatologie,  sous réserve d'une formation adaptée, d'une pratique régulière et l'application de protocole un très haut succés est atteint. Il vient en appui des analyses faites dans ces documents (1, 2)
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OBJECTIVE:

Rapid sequence intubation (RSI) is an advanced airway procedure for critically ill or injured patients. Paramedic-performed RSI in the prehospital setting remains controversial, as unsuccessful or poorly conducted RSI is known to result in significant complications. In Victoria, intensive care flight paramedics (ICFPs) have a broad scope of practice including RSI in both the adult and pediatric population. We sought to describe the success rates and characteristics of patients undergoing RSI by ICFPs in Victoria, Australia.

METHODS:

A retrospective data review was conducted of adult (≥ 16 years) patients who underwent RSI by an ICFP between January 1, 2011, and December 31, 2016. Data were sourced from the Ambulance Victoria data warehouse.

RESULTS:

A total of 795 cases were included in analyses, with a mean age of 45 (standard deviation = 19.6) years. The majority of cases involved trauma (71.7%), and most patients were male (70.1%). Neurological pathologies were the most common clinical indication for RSI (68.3%). The first pass success rate of intubation was 89.4%, and the overall success rate was 99.4%. Of the 5 failed intubations (0.6%), all patients were safely returned to spontaneous respiration. Two patients were returned via bag/valve/mask (BVM) support alone, two with BVM and oropharyngeal airway, and one via supraglottic airway. No surgical airways were required. Overall, we observed transient cases of hypotension (5.2%), hypoxemia (1.3%), or both (0.1%) in 6.6% of cases during the RSI procedure.

CONCLUSION:

A very high RSI procedural success rate was observed across the study period. This supports the growing recognition that appropriately trained paramedics can perform RSI safely in the prehospital environment.

| Tags : airway

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