Airway Management, Intubation, Intratracheal, Laryngoscopy, Vomiting
Conditions
Brief summary
In more than one-in-five cases of out-of-hospital cardiac arrest, airways are blocked by vomit and blood. Sometimes, paramedics cannot clear the airway using methods they have been taught. If the airway cannot be cleared, the patient will die. Usually, these patients will have a breathing tube placed into their windpipe (intubation), as this provides protection from vomit and blood. To do this, the paramedic needs to be able to see the entrance to the windpipe. A new method of clearing the airway called SALAD has been used in patients to help insert a breathing tube, but it is not known whether the method can help paramedics. This study will use a manikin to see if paramedics can insert a breathing tube more often on their first attempt, using SALAD.
Interventions
OTHERTraining in SALAD technique
The training session will be delivered, and will take around 45 minutes to complete, including time for participant practice. The training intervention will adopt the Advanced Life Support Group/Resuscitation Council 4-stage approach of skills teaching, and is comprised of: A real-time demonstration of the SALAD technique by the researcher; A repeated demonstration with an explanation of the rationale of the steps taken when performing SALAD (not real-time); Another demonstration of the SALAD technique conducted by the researcher, but guided by one of the participants; An attempt by the same participant who guided the researcher in the previous step, followed by a practice attempt by the other participants.
Sponsors
College of Paramedics
Yorkshire Ambulance Service NHS Trust
Study design
Observational model
CASE_CROSSOVER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Aged 18 and over * HCPC registered paramedic employed by Yorkshire Ambulance Service * Authorised to intubate within Yorkshire Ambulance Service * No SALAD training in the last 3 months
Exclusion criteria
* Not an HCPC registered paramedic employed by Yorkshire Ambulance Service * Not authorised to intubate within Yorkshire Ambulance Service * Allergy to artificial 'vomit' ingredients * Unwilling to provide consent * SALAD training in the last 3 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference in First-pass Intubation Success Rates Before and After SALAD Training | pre- and post-training as part of 2 hour study session | This measure is a comparison of Group AAB's first-pass intubation success rate, using an attempt which occurred before SALAD training, and Group ABB's intubation success rate, using an intubation attempt that occurred after SALAD training. |
Secondary
| Measure | Time frame |
|---|---|
| Difference Between Mean Time Taken (in Seconds) to Perform a Successful Intubation on the First- Attempt, Before and After SALAD Training Approximately 30 Minutes Apart. | seconds |
| Difference in Success Rates Between Participants Who Have Two Post-training Intubation Attempts Versus Participants Who Only Have One Post-training Intubation Attempt | pre- and post-training as part of 2 hour study session |
Countries
United Kingdom
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Group AAB In order to adjust for improvements in participant performance that might arise from repeated attempts at intubation, beyond that of the SALAD training itself, paramedics were randomised into one of two group. In AAB, participants randomised into making two pre-training and one post-training intubation attempts. | 82 |
| Group ABB Participants randomised into making one pre-training and two post-training intubation attempts. | 82 |
| Total | 164 |
Baseline characteristics
| Characteristic | Group AAB | Group ABB | Total |
|---|---|---|---|
| Age, Customized Adults > 18 years | 82 Participants | 82 Participants | 164 Participants |
| Awareness of SALAD technique | 15 Participants | 21 Participants | 36 Participants |
| Intubation attempts in past 12 months | 2.5 attempts | 3.0 attempts | 3.0 attempts |
| Race and Ethnicity Not Collected | — | — | 0 Participants |
| Region of Enrollment United Kingdom | 82 participants | 82 participants | 164 participants |
| Sex/Gender, Customized Gender Unknown | 82 Participants | 82 Participants | 164 Participants |
| Successful intubation attempts in past 12 months | 2 attempts | 2 attempts | 2 attempts |
| Years as a paramedic | 5 years | 3.5 years | 4 years |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 82 | 0 / 82 |
| other Total, other adverse events | 0 / 82 | 0 / 82 |
| serious Total, serious adverse events | 0 / 82 | 0 / 82 |
Outcome results
Primary
Difference in First-pass Intubation Success Rates Before and After SALAD Training
This measure is a comparison of Group AAB's first-pass intubation success rate, using an attempt which occurred before SALAD training, and Group ABB's intubation success rate, using an intubation attempt that occurred after SALAD training.
Time frame: pre- and post-training as part of 2 hour study session
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Group AAB | Difference in First-pass Intubation Success Rates Before and After SALAD Training | 44 Participants |
| Group ABB | Difference in First-pass Intubation Success Rates Before and After SALAD Training | 74 Participants |
Secondary
Difference Between Mean Time Taken (in Seconds) to Perform a Successful Intubation on the First- Attempt, Before and After SALAD Training Approximately 30 Minutes Apart.
Time frame: seconds
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Group AAB | Difference Between Mean Time Taken (in Seconds) to Perform a Successful Intubation on the First- Attempt, Before and After SALAD Training Approximately 30 Minutes Apart. | 15.4 seconds | Standard Error 3.5 |
| Group ABB | Difference Between Mean Time Taken (in Seconds) to Perform a Successful Intubation on the First- Attempt, Before and After SALAD Training Approximately 30 Minutes Apart. | 3.7 seconds | Standard Error 3.4 |
Secondary
Difference in Success Rates Between Participants Who Have Two Post-training Intubation Attempts Versus Participants Who Only Have One Post-training Intubation Attempt
Time frame: pre- and post-training as part of 2 hour study session
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Group AAB | Difference in Success Rates Between Participants Who Have Two Post-training Intubation Attempts Versus Participants Who Only Have One Post-training Intubation Attempt | 71 Participants |
| Group ABB | Difference in Success Rates Between Participants Who Have Two Post-training Intubation Attempts Versus Participants Who Only Have One Post-training Intubation Attempt | 73 Participants |