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First-Pass Intubation Success

Bedeutung und Umsetzung in der Notfallmedizin

First-pass intubation success

Relevance and implementation in emergency medicine

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Zusammenfassung

Hintergrund

Das Atemwegsmanagement ist eine der zentralen Aufgaben eines jeden notfallmedizinisch tätigen Arztes. Die prähospitale endotracheale Intubation stellt sich dabei im Vergleich zur innerklinischen Situation oft als schwieriger und komplikationsreicher dar.

Methode

Anhand der vorliegenden Literatur soll die Bedeutung einer erfolgreichen endotrachealen Intubation im ersten Versuch (sog. First-Pass Intubation Success, FPS) und der Möglichkeiten dessen Optimierung in der Notfallmedizin dargestellt und diskutiert werden.

Ergebnisse

Zahlreiche Studien zeigen, dass bei 2 oder mehr Intubationsversuchen die Rate an Komplikationen (wie z. B. Hypoxie, Aspiration, Herzkreislaufstillstand) um den Faktor 4 bis 7 ansteigt. Die vorliegende Literatur macht deutlich, dass eine wesentliche Voraussetzung für einen möglichst hohen FPS und damit eine hohe Patientensicherheit insbesondere eine gute Ausbildung und regelmäßiges Training in der endotrachealen Intubation ist. Eine Narkoseeinleitung sollte standardisiert und nach sorgsamer Präoxygenierung erfolgen. Die Bedeutung des Einsatzes von Muskelrelaxanzien und der Videolaryngoskopie für den FPS steht zur Diskussion.

Abstract

Background

Airway management is a central skill for every physician working in emergency medicine. Endotracheal intubation in the prehospital setting has been proven to be more difficult and complicated as compared to the in-hospital setting.

Method

Therefore, on the basis of the existing literature the importance of the first-pass intubation success (FPS) and the possibilities for its optimization are addressed and discussed.

Results

Several studies have shown a 4 to 7 times higher rate of complications (e.g., hypoxia, aspiration, cardiac arrest) after 2 or more intubation attempts. Current literature demonstrates that education and frequent training is a major prerequisite for a maximum FPS and patient safety. Induction of anesthesia should be standardized and after careful pre-oxygenation. The relevance of neuromuscular blocking agents and video laryngoscopy for FPS is discussed.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und Schmerztherapie, Universitätsspital Bern, Universität Bern, Freiburgstrasse 4, 3010, Bern, Schweiz

    J. Knapp & R. Greif

  2. Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Innsbruck, Österreich

    V. Wenzel

  3. Klinik für Anästhesiologie und Intensivmedizin, Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland

    B. Hossfeld

  4. Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland

    M. Bernhard

  5. Arbeitsgruppe „Trauma- und Schockraummanagement“, Arbeitskreis Notfallmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, Nürnberg, Deutschland

    M. Bernhard

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Correspondence to J. Knapp.

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J. Knapp, V. Wenzel, R. Greif, B. Hossfeld und M. Bernhard geben an, dass kein Interessenkonflikt besteht.

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Knapp, J., Wenzel, V., Greif, R. et al. First-Pass Intubation Success. Notfall Rettungsmed 19, 566–573 (2016). https://doi.org/10.1007/s10049-016-0168-3

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