Telemedicine -Assisted Intubation In Rural Emergency Departments: A National Emergency Airway Registry Study

Comment: This Database Study is very important as a harbinger of the future that we are about to see . The tools for excellence in airway management are now available and the future depends on the development of an airway culture that elevates the professions use of these tools. 

 Telemedicine -Assisted Intubation In Rural Emergency Departments: A National Emergency Airway Registry Study

Lucas Van Oeveren, MD,1,2  Julie Donner, MS,2

 Andrea Fantegrossi, MPH,3  Nicholas M. Mohr, MD, MS,4,5

 and Calvin A. Brown III, MD3,6

1 Section of Emergency Medicine, Avera McKennan Hospital,

Sioux Falls, South Dakota.

2 Avera eCARE, Avera Health System, Sioux Falls, South Dakota.

3 Department of Emergency Medicine, Brigham and Women’s

Hospital, Boston, Massachusetts.

4 Department of Emergency Medicine, Division of Critical Care,

and 5 Department of Anesthesia, University of Iowa Carver

College of Medicine, Iowa City, Iowa.

6 Harvard Medical School, Boston, Massachusetts.

Abstract
Background: Intubation in rural emergency departments (EDs)
is a high-risk procedure, often with little or no specialty support.
Rural EDs are utilizing real-time telemedicine links,
connecting providers to an ED physician who may provide
clinical guidance. Introduction: We endeavored to describe
telemedicine-assisted intubation in rural EDs that are served by
an ED telemedicine network. 

Materials and Methods: 

Prospective data were collected on all patients who had an intubation attempt while on the video telemedicine link from May
1, 2014 to April 30, 2015. We report demographic information,
indication, methods, number of attempts, operator characteristics,
telemedicine involvement/intervention, adverse
events, and clinical outcome by using descriptive statistics.
Results: Included were 206 intubations. The most common
indication for intubation was respiratory failure. First-pass
success rate (postactivation) was 71%, and 96% were eventually
intubated. Most attempts (66%) used rapid-sequence
intubation. Fifty-four percent of first attempts used video laryngoscopy
(VL). Telemedicine providers intervened in 24%,
43%, and 55% of first–third attempts, respectively. First-pass
success with VL and direct laryngoscopy was equivalent (70%
vs. 71%, p = 0.802). Adverse events were reported in 49 cases
(24%), which were most frequently hypoxemia. 

Discussion:

The impact of telemedicine during emergency intubation is not
defined. We showed a 71% first-pass rate post-telemedicine
linkage (70% of cases had a previous attempt). Our ultimate
success rate was 96%, similar to that in large-center studies.
Telemedicine support may contribute to success.

Conclusions:

Telemedicine-supported endotracheal intubation performed in
rural hospitals is feasible, with good success rates. Future research
is required to better define the impact of telemedicine
providers on emergency airway management.
Keywords: telemedicine, emergency medicine, teletrauma,
telehealth, e-health
Introduction