French physicians provide pre-hospital critical care in medical teams of regional SAMU (service d’aide me ́dicale urgente). A national guideline was introduced in France to guide the management of traumatic brain injury (TBI), which included airway management. A study was conducted which examined the practice of paediatric pre-hospital intubation in TBI in comatose children both before and after the introduction of the guideline.
After the guideline there were more pre-hospital intubations, with more standardised approach to rapid sequence induction(RSI). There were fewer complications and a 100% intubation success rate. Despite an increase in portable capnography use, PaCO2 was measured outside the recommended range of 35– 40 mmHg (3.5-4.5 kPa) in 70% of the cases upon arrival.
Emergency tracheal intubation of severely head-injured children: Changing daily practice after implementation of national guidelines
Pediatr Crit Care Med. 2010 May 13. [Epub ahead of print]