Definitive Airway Management in the Critical Care Transport Medicine Environment: An Exploratory Convenience Survey-Based Analysis of Retrieval Experts on the Profound Shock State Patient

Objective: Airway management in profoundly unstable patients, particularly those in a peri-arrest state, remains a contentious issue in out-of-hospital environments. Although there is robust literature on advanced airway procedures for acutely ill patients, literature on prehospital patients in profound shock is sparse. This study represents a survey-based analysis of critical care transport medicine (CCTM) experts to describe the challenges and strategies for intubating patients with significant hemodynamic instability. Methods: Before the Air Medical Physician Symposium (AMPS) Lite, an online exploratory survey was developed from a convenience sample of AMPS attendees regarding best practices, knowledge gaps, barriers to translation, and research priorities. AMPS featured educational lectures and discussions on critical care transport topics, including definitive airway management for patients in profound shock. Participants included CCTM experts from a variety of programs across the United States and internationally. The symposium included expert panel discussions and audience ranking of these categories using electronic voting. Results: The survey-based analysis highlighted the importance of understanding the physiological and pharmacological principles surrounding rapid sequence intubation and other intubation strategies. Rankings emphasized the need for research on shock dosing of sedatives and the potential for paralytic-only intubation in profoundly obtunded patients. Conclusion: The study concluded that further investigation is needed to develop evidence-based guidelines for intubating patients in profound shock. The findings suggest that reduced sedation dosing and consideration of using paralytic-only intubation may mitigate the risks of cardiovascular collapse and improve patient outcomes in this critically ill patient population.