Soiled Airway Tracheal Intubation and the Effectiveness of Decontamination by Paramedics

What is the SATIATED study?

SATIATED is a randomised trial which aims to determine whether paramedic first-pass intubation success of a simulated contaminated airway improves following training in Suction Assisted Laryngoscopy and Airway Decontamination (SALAD).

Why is this study being done?

In more than one-in-five cases of out-of-hospital cardiac arrest, airways are blocked by vomit and blood. Sometimes, paramedics cannot clear the airway using methods they have been taught. If the airway cannot be cleared, the patient will die. Usually, these patients will have a breathing tube placed into their windpipe (intubation), as this provides protection from vomit and blood, but this can be difficult to perform when the airway is blocked. This is because, the paramedic needs to be able to see the entrance to the windpipe in order to successfully intubate.

A new method of clearing the airway called SALAD has been used in patients to help insert a breathing tube, but we don’t know whether the method can help paramedics. However, to date there has only been one study specifically looking at the SALAD technique and the outcomes were self-reported confidence measures of trainees in using the technique. Other techniques have been described to manage significant airway contamination, including the use of a meconium aspirator (normally only used in newborn babies) which is not practical in the out-of-hospital environment and requires a device that is not typically carried by UK ambulance services, and deliberate intubation of the gullet (oesophagus) to allow vomit to pass out of the mouth via the tube, instead of into the mouth. However, only one case report exists in support of this procedure.

Prior to undertaking clinical studies, it is important to determine the feasibility of teaching the technique to paramedics in a brief training session, and testing whether it has a beneficial effect on paramedic intubation success. Training needs to be concise given the operational demands of the ambulance service at present, which is placing training time under increasing pressure. A training programme that required a whole day to undertake, for example, would not be pragmatic to implement.

Who can get involved in SATIATED?

This study is being carried out in Yorkshire Ambulance Service (YAS) and is open to paramedics who are employed by YAS. You can find out more information on the Study Paramedics page.

Funding

This study has been funded by a College of Paramedics small research grant. If you are a full member of the College, you are eligible to apply. Visit the Research and Development Advisory Committee page.

Trial registration

ClinicalTrials.gov identifier: NCT03599687