Soiled airway tracheal intubation and the effectiveness of decontamination by united kingdom paramedics (Satiated2): A randomised controlled manikin study

Introduction 

Vomiting and regurgitation are commonly encountered in out-of-hospital cardiac arrest, but traditional paramedic suctioning techniques may be insufficient to manage severely soiled airways. The Suction Assisted Laryngoscopy and Airway Decontamination (SALAD) technique was developed to help clinicians manage soiled airways. SATIATED2 reports the impact of SALAD training in North East Ambulance Service (NEAS) in the United Kingdom following the original SATIATED study in the Yorkshire Ambulance Service. The primary research question was: Among NEAS paramedics, does the addition of SALAD training, compared to standard training, improve the success rate of intubation for the soiled airway? 

Methods 

A randomised controlled trial of SALAD was conducted using a modified airway manikin capable of vomiting. The intervention comprised SALAD training and the introduction of the DuCanto catheter. Paramedic volunteers were block randomised into two groups: A₀₁A₀₂B₀₁ who made two pre-training intubation attempts and one post-training attempt, and A₁₁B₁₁B₁₂, who made one pre-training and two post-training attempts. The primary outcome was intubation success rate at the second attempt. The time taken to intubate was recorded as a secondary outcome. SATIATED2 was registered with ISRCTN (ISRCTN17329526) and funded internally with commercial support from SSCOR who supplied the DuCanto catheters. 

Results 

One-hundred and two paramedics (51 AAB, 51 ABB) were recruited between August and December 2019 with 99 participating (50 AAB, 49 ABB). The primary outcome was intubation success rate on the second attempt (A₀₂ vs. B₁₁) which were 86% without SALAD and 96% with SALAD; a non-significant improvement of 10% (95% CI: 1–21, p=0.09). The total intubation success rate pre-training (A₀₁ +A₀₂+A₁₁) was 75% (112/149) compared with 98% (145/148) post-training (B₀₁+B₁₁+B₁₂). 

Conclusion 

NEAS paramedics demonstrated improved, but non-significant, intubation success rates in a simulated soiled airway following SALAD training.