Arulkumaran N, McLaren CS, Arulkumaran K, Philips BJ, Cecconi M. An analysis of emergency tracheal intubations in critically ill patients by critical care trainees. J Intensive Care Soc. 2018; 19:(3)180-187

Campbell J. Regulation of Advanced Critical Care Practitioners: Past, present and future. J Intensive Care Soc. 2020; 21:(1)7-11

Cook TM, Woodall N, Harper J, Benger J Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesthesia. 2011; 106:(5)632-42

Delorenzo A, St Clair T, Andrew E, Bernard S, Smith K. Prehospital rapid sequence intubation by intensive care flight paramedics. Prehosp Emerg Care. 2018; 22:(5)595-601

Denton G, Green L, Palmer M The provision of central venous access, transfer of critically ill patients and advanced airway management.: Are advanced critical care practitioners safe and effective?. J Intensive Care Soc. 2019; 20:(3)248-254

Denton G, Green L, Palmer M Evaluation of the safety of inter-hospital transfers of critically ill patients led by advanced critical care practitioners. Br J Nurs. 2021; 30:(8)470-476

Department of Health, Skills for Health. The national education and competency framework for advanced critical care practitioners. 2008. (accessed 23 May 2022)

Faculty of Intensive Care Medicine. Curriculum for training for advanced critical care practitioners: Part III—syllabus. v1.1. 2018 (updated version of document first published 2015). (accessed 23 May 2022)

Faculty of Intensive Care Medicine. Advanced airway management for advanced critical care practitioners. ACCP optional skills framework. 2022. (accessed 26 May 2022)

Gellerfors M, Fevang E, Bäckman A, Krüger A Pre-hospital advanced airway management by anaesthetist and nurse anaesthetist critical care teams: a prospective observational study of 2028 pre-hospital tracheal intubations. Br J Anaesthesia. 2018; 120:(5)1103-1109

Gunning M, Perkins Z, Crilly J, von Rahden R. Paramedic rapid sequence induction (RSI) in a South African emergency medical service: A retrospective observational study. S Afr Med J. 2013; 103:(9)632-637

Higgs A, McGrath BA, Goddard C Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesthesia. 2018; 120:(2)323-352

McQueen C, Crombie N, Hulme J Prehospital anaesthesia performed by physician/critical care paramedic teams in a major trauma network in the UK: a 12 month review of practice. Emerg Med J. 2015; 32:(1)65-69

Park L, Zeng I, Brainard A. Systematic review and meta-analysis of first-pass success rates in emergency department intubation: Creating a benchmark for emergency airway care. Emerg Med Australas. 2017; 29:(1)40-47

Russotto V, Myatra SN, Laffey JG Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries. JAMA. 2021; 325:(12)1164-1172

Sakles JC, Chiu S, Mosier J, Walker C, Stolz U. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emergy Med. 2013; 20:(1)71-78

Stevenson AGM, Graham CA, Hall R, Korsah P, McGuffie AC. Tracheal intubation in the emergency department: the Scottish district hospital perspective. Emerg Med J. 2007; 24:(6)394-397

Williams C, Bennett E, Bromage N. Advanced critical care practitioners - Practical experience of implementing the Advanced Critical Care Practitioner Faculty of Intensive Care Medicine Curriculum in a London Critical Care Unit: Response letter. J Intensive Care Soc. 2019; 20:(1)NP1-NP2

Advanced airway management and drug-assisted intubation skills in an advanced critical care practitioner team

09 June 2022
Volume 31 · Issue 11



Airway management, including endotracheal intubation, is one of the cornerstones of care of critically ill patients. Internationally, health professionals from varying backgrounds deliver endotracheal intubation as part of their critical care role. This article considers the development of airway management skills within a single advanced critical care practitioner (ACCP) team and uses case series data to analyse the safety profile in performing this aspect of critical care. Skills were acquired during and after the ACCP training pathway. A combination of theoretical teaching, theatre experience, simulation and work-based practice was used. Case series data of all critical care intubations by ACCPs were collected. Audit results: Data collection identified 675 intubations carried out by ACCPs, 589 of those being supervised, non-cardiac arrest intubations requiring drugs. First pass success was achieved in 89.6% of cases. A second intubator was required in 4.3% of cases. Some form of complication was experienced by 42.3% of patients; however, the threshold for complications was set at a low level.


This ACCP service developed a process to acquire advanced airway management skills including endotracheal intubation. Under medical supervision, ACCPs delivered advanced airway management achieving a first pass success rate of 89.6%, which compares favourably with both international and national success rates. Although complications were experienced in 48.3% of patients, when similar complication cut-offs are compared with published data, ACCPs also matched favourably.

Airway management, including endotracheal intubation, is one of the cornerstones of care of the critically ill patient. Multiple reports have examined the role of health professionals from varying backgrounds who have delivered endotracheal intubation as part of their critical care role (Gunning et al, 2013; Delorenzo et al, 2018; Gellerfors et al, 2018). In the UK, drug-assisted endotracheal intubation has remained restricted to a small number of professional groups, and within adult critical care has been almost exclusively performed by physicians. UK advanced practitioners in paediatric, neonatal and pre-hospital care perform drug-assisted endotracheal intubation as part of a multidisciplinary team (with medical supervision). However, published research on the subject is scant. Critical care paramedics (working within specialist prehospital care teams and under medical supervision) perform drug-assisted endotracheal intubation, as do anaesthesia associates (in the theatre environment) (McQueen et al, 2015). In the past 14 years advanced critical care practitioners (ACCPs) have been added to the multidisciplinary team of UK intensive care units (ICUs). Many aspects of ACCP practice have been described, including advanced airway management (Department of Health and Skills for Health, 2008; Faculty of Intensive Care Medicine, 2018; Denton et al, 2019; Williams et al, 2019; Denton et al, 2021). The extent to which ACCPs are involved in airway management varies between services with varying degrees of maturity and remains a contentious issue for medical colleagues.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content