ABSTRACTS
Advanced Airway Management in Pregnant Patients in the Prehospital SettingAuthor: Caitlin Delaney MS, NRP | Medical Student | University At Buffalo Associate Authors: Reuter, Mitchel, L. MSEMS, CCEMT-P, NRP | Koontz, Katherine, J. BS, NREMT | Milliman, Joseph, C. MBA, AEMTP | Rosen, Joshua, A. MBA, NREMT | Beckstead, Rylee, E. MStat | Jarvis, Jeffery L. MD, MS, EMT-P
Introduction Respiratory distress accounts for 12% of all US 911 calls. Despite the unique respiratory physiology in pregnancy, no literature examines prehospital invasive airway management in this population. We aimed to characterize airway interventions in pregnant patients treated by emergency medical services (EMS), focusing on gestational age (GA), indications for airway management, and interventions utilized. We analyzed device selection (endotracheal intubation [ETI], direct versus video laryngoscopy [VL] and supraglottic airways [SGAs]) to identify patterns in prehospital airway management. Methods We conducted a retrospective cohort study of all pregnant patients with documented 911 EMS invasive airway interventions in the 2023 ESO Data Collaborative. Suspected but unconfirmed pregnancies and non-911 EMS (e.g., interfacility transports) were excluded. We analyzed demographics, clinical characteristics and airway management, including GA (<20 weeks, >20 weeks, and GA unknown), provider-determined indications for invasive airway management, type of ETI, SGA use, and invasive airway-related procedures. Descriptive statistics summarized airway interventions, and comparative analysis examined associations between GA and invasive airway use. Results Among 69,733 pregnant patients, 47 (0.07%) received 67 invasive airway-related procedures. GA was <20 weeks in 7/47 (14.9%), >20 weeks in 19/47 (40.4%), and unknown in 21/47 (44.7%). Among patients with known GA, there was no significant association with airway use (p= 0.40). Cardiac arrest was present in 39/47 (83.0%) cases. Etiology of cardiac arrest was categorized as medical (74.4%), trauma (20.5%), or unclassified (5.1%). Among medical cardiac arrest, the etiology was presumed cardiac (62.1%), respiratory (24.1%), or drug overdose (13.8%). ETI was performed in 24 of 47 cases (51.1%), with VL utilized in 4 of 24 intubations (16.7%). SGAs were placed in 29 of 47 cases (61.7%). ETI was successful in 17 of 24 attempts (70.8%), while SGAs were successfully placed in 28 of 29 attempts (96.6%). We found significant variation between the type of airway device used and successful airway management (p= 0.03 with Yates correction). Conclusion Prehospital invasive airway interventions in pregnant patients are rare and usually occur in cardiac arrest. We found no significant association between GA and airway management, but unadjusted success rates were higher with SGAs than ETIs in this small, retrospective sample.
|
