Adverse events associated with emergency intubations: 12,000 intubations from national emergency airway registry
Roy R, Flo F, Kilgo R, Wells R, and Jayaprakash N. Adverse events associated with emergency intubations: 12,000 intubations from national emergency airway registry. Acad Emerg Med 2019; 26:S42.
Acad Emerg Med
Background: We evaluate intubation methods and associations with adverse events (AEs) and first pass success in over 12,000 Emergency Department (ED) intubations. Methods: Academic EDs in the USA recorded over 12,000 ED intubations at 25 Institutions from Feb 2016-Feb 2018. These intubations were collected prospectively through a web based tool (StudyTRAX) for the National Emergency Airway Registry (NEAR). EDs had to have a 90% compliance rate to be included in the registry. We discuss associations between intubation characteristics, AEs and first pass success (FPS). The intubation characteristics assessed are methods used, device used, induction agent used, paralytic used, and intubator level (resident, faculty). Logistic regression analysis will be used to compare these variables with FPS and AEs. Results: FPS has remained at 85% since the 1990's. VL has surpassed DL as the predominant mode of intubation in this study. Earlier studies showed esophageal intubations were the predominate AE. In this review of NEAR, esophageal intubations accounted for less than 1% of the AEs. AEs occurred in 13% of patients overall, of which hypoxia accounted for 7-8% and hypotension accounted for 4%, comprising more than 90% of all AEs. The remainder of AEs for this study had a total of less than 1% occurrence rate. No intubation characteristic came to predominate with any of the AEs. Higher AE rates were observed in medical patients and in patients with Ketamine use. While the AE rate was similar with either VL or DL, the VL use resulted in a higher FPS rate across the majority of intubations. Conclusion: This data shows that while the device utilized (VL or DL) has changed, the rate of AEs is similar between the two groups despite an associated higher FPS with VL. When faced with a difficult intubation in the ED, it is paramount that the intubation characteristics reviewed here are not the factors associated with AEs in the hands of trained ED providers. These findings suggest areas of further study in order to improve patient oriented outcomes and allow the intubator to make informed decisions when intubating critically ill and injured patients.