Guidance documents

College of Paramedics Statement on Intubation, available here.

AAGBI Safer Prehospital Anaesthesia 2017, available here.



Recommended Rich Levitan resources

Airway axes

From: McGuire B, Hodge K. Tracheal intubation. Anaesthesia & Intensive Care Medicine. 2019. 20(12);681-686.


Bimanual Laryngoscopy

It should be noted that this is not entirely consistent with current standard UK practice, as it discusses cricoid pressure and a stylet being used in the ETT, rather than a bougie

Further resources

Article available here.

Click here to hear what our friends over at the Resus Room think about Airways 2

References (kindly shared by Rich)

Davis DP et al. The Effect of Paramedic Rapid Sequence Intubation on Outcome in Patients with Severe Traumatic Brain Injury. J Trauma 2003; 54:444-453

Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscope attempts. Anesth Analg. 2004 Aug;99(2):607-13, 

Hasegawa K et al. Association Between Repeated Intubation Attempts and Adverse Events in Emergency Departments: An Analysis of a Multicenter Prospective Observational Study. Annals of Emergency Medicine 2012; Volume 60, Issue 6, Pages 749–754.e2

Delson NJ et. al., Anesthesia and Analgesia, 2002; 94; S-123.

Levitan RM et al. Laryngeal View During Laryngoscopy: A Randomized Trial Comparing Cricoid Pressure, Backward-Upward-Rightward Pressure, and Bimanual Laryngoscopy. Annals of Emergency Medicine 2006; 47(6):548-555

Lewis  SR, Butler  AR, Parker  J, Cook  TM, Smith  AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD011136. DOI:10.1002/14651858.CD011136.pub2. 

Breckwoldt J, Klemstein S, Brunne B, Schnitzer L, Mochmann HC, Arntz HR. Difficult prehospital endotracheal intubation – predisposing factors in a physician based EMS. Resuscitation. 2011 Dec;82(12):1519-24. doi: 10.1016/j.resuscitation.2011.06.028. Epub 2011 Jul 2. PMID: 21749908.

Bossers SM, Schwarte LA, Loer SA, Twisk JW, Boer C, Schober P. Experience in Prehospital Endotracheal Intubation Significantly Influences Mortality of Patients with Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. PLoS One. 2015 Oct 23;10(10):e0141034. doi: 10.1371/journal.pone.0141034. PMID: 26496440; PMCID: PMC4619807.

Sunde, G.A., Heltne, J., Lockey, D. et al. Airway management by physician-staffed Helicopter Emergency Medical Services – a prospective, multicentre, observational study of 2,327 patients. Scand J Trauma Resusc Emerg Med 23, 57 (2015).

Crewdson, K., Lockey, D.J., Røislien, J. et al. The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis. Crit Care 21, 31 (2017).

Gellefors M et al. Pre-hospital advanced airway management by anaesthetist and nurse anaesthetist critical care teams: a prospective observational study of 2028 pre-hospital tracheal intubations. British Journal of Anaesthesia, 120 (5): 1103e1109 (2018)

Konrad, Christoph MD; Schupfer, Guido MD, MBA HSG; Wietlisbach, Markus MD; Gerber, Helmut MD, PhD Learning Manual Skills in Anesthesiology: Is There a Recommended Number of Cases for Anesthetic Procedures?, Anesthesia & Analgesia: March 1998 – Volume 86 – Issue 3 – p 635-639. doi: 10.1213/00000539-199803000-00037

de Oliveira Filho, Getúlio Rodrigues, MD The Construction of Learning Curves for Basic Skills in Anesthetic Procedures: An Application for the Cumulative Sum Method, Anesthesia & Analgesia: August 2002 – Volume 95 – Issue 2 – p 411-416 doi: 10.1213/00000539-200208000-00033

Je S, Cho Y, Choi HJ, et al An application of the learning curve–cumulative summation test to evaluate training for endotracheal intubation in emergency medicine Emergency Medicine Journal 2015;32:291-294.

Toda, J., Toda, A.A. & Arakawa, J. Learning curve for paramedic endotracheal intubation and complications. Int J Emerg Med 6, 38 (2013).

Breckwoldt J, Klemstein S, Brunne B, Schnitzer L, Mochmann H-C, Arntz H-R. Difficult prehospital endotracheal intubation – predisposing factors in a physician based EMS. Resuscitation. 2011;82:1519–24

One thought on “Intubation

  1. Pingback: Intubation – Prehospital and Retrieval Medicine – THE PHARM dedicated to the memory of Dr John Hinds

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s