Cabin configuration and prolonged oral endotracheal intubation in the AS365N2 Dauphin EMS helicopter.

INTRODUCTION

Most patients transported by air who require endotracheal intubation undergo endotracheal intubation before transport. However, in-flight endotracheal intubation may be indicated in the setting of certain scene conditions, in-flight patient deterioration, or endotracheal tube dislodgement. A previous report of high endotracheal intubation efficacy in the BK-117 in-flight recommended that flight programs review endotracheal intubation capabilities in their own aircraft. This study was conducted to determine whether in-aircraft endotracheal intubation times in the AS365N2 Dauphin were comparable to those previously reported for the BK-117.

SETTING

AS365N2 and BK-117 helicopters stationary on a helipad.

METHODS

Eight flight team members per formed three mannequin endotracheal intubations in each aircraft. Three time intervals were assessed: Setup, time required for equipping and positioning for endotracheal intubation; placement, time from laryngoscopy to endotracheal intubation; and total (Setup + Placement). Mean times for the BK-117 and AS365N2 were compared using the t test (a=0.05).

RESULTS

All endotracheal intubation attempts were successful, but setup (p=0.0001), placement (p=0.0271), and total (p=0.0011) times were longer in the Dauphin. Crew members unanimously expressed endotracheal intubation difficulty caused by positioning problems in the Dauphin.

CONCLUSION

In-aircraft intubation is significantly more time-consuming in the Dauphin than in the BK-117. This prolongation of intubation appears to be due to problems with positioning of the air medical crew and patient.