The effect of Combitube use on paramedic experience in endotracheal intubation

Abstract Objective To determine the change in number of endotracheal intubations per paramedic after the implementation of Combitube use and to explore consequences. Methods Before-and-after study; urban/suburban EMS system; population 1 million. Number of patients 16 years and older, type of airway used, attempts, and successes were abstracted for time periods before and after the use of Combitubes. The number of endotracheal intubations/paramedic for each period was calculated. Results Three-year pre-Combitube: patients 50 983; 6.6% arrests; 3142 received an endotracheal intubation attempt with 93.5% success. The average annual number of paramedics was 153 with 6.9 ± 6.4 intubations per paramedic per year. Three-year post-Combitube: patients 55 959; 6.0% arrests; 2913 received an advanced airway attempt: 860 Combitubes, success 89.4%; 2144 endotracheal intubations, success 91.6% (95% confidence interval success rate difference, 0.5-3.3; P = .007). The average annual number of paramedics was 177 with 3.7 ± 3.3 intubations per paramedic per year. Conclusion After implementation of the Combitube, the number of endotracheal intubation attempts/paramedic and success rates decreased.