Emergency intubation in trauma in KwaZulu-Natal Province, South Africa

C T Lewis, J Brown, A C Inglis, D N Naumann, N Crombie


Background. Advanced airway management is a research priority in prehospital care. There is a high burden of major trauma in KwaZulu-Natal (KZN) Province, South Africa (SA), and transfer times to trauma units are often prolonged.

Objectives. To examine emergency intubation practice in trauma and burns patients in Pietermaritzburg, KZN, and its environs.

Methods. This was a prospective consecutive case series, conducted from 11 May to 17 July 2016. Data were collected from urban emergency department (ED), rural hospital and roadside procedures in Pietermaritzburg and its drainage area. Patients with emergency intubation following trauma were eligible for inclusion. The primary outcome was successful airway management. Secondary outcomes included first-pass success and adverse events.

Results. Forty-one cases were recorded in patients aged 1 - 60 years. No instances of unsuccessful airway management were reported. Recorded first-pass intubation success rates were higher in receiving EDs than rural hospitals (19/22 v. 2/7; p=0.003). Use of a formal preintubation checklist was associated with a higher first-pass success rate (21/23 v. 6/15; p=0.001) and fewer adverse events (0/23 v. 7/16; p<0.001). Identified adverse event rates were 1/22 (EDs), 5/8 (rural hospitals) and 2/9 (roadside). Unmedicated intubation was more common in rural hospitals than EDs (3/8 v. 1/22; p=0.019), despite absence of cardiac arrest in these cases. Minimum standards of anaesthetic monitoring were not consistently met in any setting.

Conclusions. The use of a preprocedural checklist was associated with improved intubation outcomes and may improve practice in SA trauma care and the prehospital environment, including in rural hospitals. Standardised rapid sequence induction protocols, routine use of introducers and end-tidal carbon dioxide monitoring, and increased availability of intraosseous devices also merit consideration. Key performance indicators should be monitored routinely.


Authors' affiliations

C T Lewis, Academic Foundation Programme, Raigmore Hospital, Inverness, UK

J Brown, Netcare 911, Pietermaritzburg, South Africa

A C Inglis, Emergency Medicine, Edendale Hospital, Pietermaritzburg, South Africa

D N Naumann, National Institute for Health Research, Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK

N Crombie, National Institute for Health Research, Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK

Full Text



Airway management; Emergency care systems; Prehospital care; Rural hospitals; South Africa

Cite this article

South African Medical Journal 2018;108(8):660-666. DOI:10.7196/SAMJ.2018.v108i8.12670

Article History

Date submitted: 2018-07-25
Date published: 2018-07-25

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