Effect of Airway-Securing Method on Prehospital Endotracheal Tube Dislodgment

Abstract

Objective. We compared the effectiveness of common airway-securing techniques in preventing endotracheal tube (ETT) dislodgment in the prehospital setting. Methods. This was a prospective, observational, multicenter study conducted at 42 emergency medical services (EMS) agencies. EMS providers completed structured, closed-response data forms for all endotracheal intubation (ETI) attempts during an 18-month period. We included all successful intubations as well as failed ETIs in which ETT securing was performed. EMS providers indicated methods used to secure the ETT, including the use of adhesive tape to the face (face tape), tape wrapped around the neck (neck tape), woven twill or umbilical tape (twill tape), intravenous or oxygen tubing (tubing), commercial tube holders, and manual stabilization/none. Providers also indicated the concurrent use of a cervical collar and/or cervical immobilization device (CID) with backboard. ETT dislodgment was reported by providers. We evaluated the rates and odds of ETT dislodgment for each tube-securing technique using multivariate logistic regression. Results. Of 1,732 patients undergoing tube-securing efforts, ETT dislodgment occurred in 51 (2.9%). ETT dislodgment rates were as follows: tube held manually, four of 32 (12.5%); face tape, 13 of 292 (4.5%); neck tape, nine of 205 (4.4%); twill tape, zero of 67 (0%); tubing, one of 30 (3.3%); commercial tube holders, 25 of 1,111 (2.3%); cervical collar, two of 121 (1.7%); and CID, 12 of 377 (3.2 %). On multivariate regression, when compared with securing the tube with face tape, only manually holding the tube in place showed a significant difference in the odds of dislodgment (odds ratio [OR] 5.0, 95% confidence interval [CI] 1.2–15.2). Whereas cardiac arrest and trauma did not increase the odds of ETT dislodgment (OR 1.3, 95% CI 0.7–2.6; and OR 0.3, 95% CI 0.1–1.4, respectively), patient age less than 5 years was associated with ETT dislodgment (OR 6.6, 95% CI 2.2–19.7). Conclusion. In this multicenter observational series, the odds of ETT dislodgment were similar for face tape, neck tape, twill tape, plastic tubing, and commercial tube holders. ETT dislodgment did not occur with woven twill tape. Patients under 5 years of age are at heightened risk for ETT dislodgment.

Key words: :

• endotracheal tube
• dislodgment
• intubation
• extubation
• complications
• prehospital