Repeated attempts at tracheal intubation by a single intubator associated with decreased success rates in emergency departments: an analysis of a multicentre prospective observational study

Goto, Tadahiro; Watase, Hiroko; Morita, Hiroshi; Nagai, Hideya; Brown, Calvin A.; Brown, David F.M.; Hasegawa, Kohei

doi:10.1136/emermed-2013-203473

Cited by 26 publications

(31 citation statements)

References 15 publications

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“…First, we performed the analysis using different definitions of difficult intubation: (1) an intubation course that requires 3 or more attempts by emergency physicians or anesthesiologists and (2) IDS score at least 6 [18]. Second, we repeated the analysis with excluding patients whose first attempt was performed by a transitional year resident (postgraduate year 1 or 2) because the intubator's level of training is deemed to influence the intubation success rate [12,13,21]. Third, we also repeated the analysis excluding patients with airway obstruction because these patients are more likely to be managed with surgical airway management or by other specialists.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the proportion of difficult intubation ranges from 10% to 27% in the ED setting [2][3][4][5], whereas the rate ranges from 1% to 9% of elective intubation in the anesthesia setting [6][7][8][9][10]. Because emerging evidence demonstrates that repeated intubation attempts are associated with an increased risk of adverse events [11][12][13], early recognition of difficulty intubation with a systematic use of rescue methods in ED patients is critical [12,13].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prospective validation of the modified LEMON criteria to predict difficult intubation in the ED

Hagiwara

Watase

Okamoto

et al. 2015

The American Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prospective validation of the modified LEMON criteria to predict difficult intubation in the ED

Hagiwara

Watase

Okamoto

et al. 2015

The American Journal of Emergency Medicine

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“…The goals of the algorithm are to promote rapid decision‐making, reduce errors, and improve the quality of airway management . In emergency airway management, identification of the difficult airway is a crucial step to achieve first‐pass success and avoid encountering a “cannot intubate, cannot ventilate” situation . The presence of difficult airway is a key branch point to achieve safe, successful intubation (Fig.…”

Section: Airway Management Algorithm and Difficult Airwaysmentioning

confidence: 99%

“…This approach is also supported by the data from a large multicenter registry. For example, second intubation attempts by a single intubator, compared with those by alternate intubators, were associated with a decreased success rate . Likewise, rescue intubation by emergency physicians or senior physicians is also associated with a higher probability of success at the second attempt …”

Section: Rescue Intubationmentioning

confidence: 99%

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Advancing emergency airway management practice and research

Goto

Hagiwara

et al. 2019

Acute Medicine & Surgery

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Emergency airway management is one of the vital resuscitative procedures undertaken in the emergency department (ED). Despite its clinical and research importance in the care of critically ill and injured patients, earlier studies have documented suboptimal intubation performance and high adverse event rates with a wide variation across the EDs. The optimal emergency airway management strategies remain to be established and their dissemination to the entire nation is a challenging task. This article reviews the current published works on emergency airway management with a focus on the use of airway management algorithms as well as the importance of first‐pass success and systematic use of rescue intubation strategies. Additionally, the review summarizes the current evidence for each of the important airway management processes, such as assessment of the difficult airway, preparation (e.g., positioning and oxygenation), intubation methods (e.g., rapid sequence intubation), medications (e.g., premedications, sedatives, and neuromuscular blockades), devices (e.g., direct and video laryngoscopy and supraglottic devises), and rescue intubation strategies (e.g., airway adjuncts and rescue intubators), as well as the airway management in distinct patient populations (i.e., trauma, cardiac arrest, and pediatric patients). Well‐designed, rigorously conducted, multicenter studies that prospectively and comprehensively characterize emergency airway management should provide clinicians with important opportunities for improving the quality and safety of airway management practice. Such data will not only advance research into the determination of optimal airway management strategies but also facilitate the development of clinical guidelines, which will, in turn, improve the outcomes of critically ill and injured patients in the ED.

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Factors associated with successful rescue intubation attempts in the emergency department: an analysis of multicenter prospective observational study in Japan

Goto

Okamoto

et al. 2019

Acute Medicine & Surgery

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It remains unclear whether physicians should change intubation approaches after the failed first attempt. We aimed to determine the rescue intervention approaches associated with a higher success rate at the second attempt in the emergency department (ED). Methods: We analyzed the data from a prospective, multicenter, observational studythe second Japanese Emergency Airway Network Study. The current analysis included all patients who underwent emergency intubation from February 2012 through November 2017. We defined a rescue intubation attempt as a second intubation attempt with any change in intubation approaches (i.e., change in methods, devices, or intubators) from the failed first attempt. The outcome measure was second-attempt success. Results: Of 2,710 patients with a failed first attempt, 43% underwent a second intubation attempt with changes in intubation approach (i.e., rescue intubation). Rescue intubation attempts were associated with a higher second-attempt success rate compared to non-rescue intubation attempts (adjusted odds ratio [OR], 1.78; 95% confidence interval [CI], 1.50-2.12). The rescue intubation approaches associated with a higher second-attempt success were changes from non-rapid sequence intubation (RSI) to RSI (adjusted OR, 2.04; 95% CI, 1.12-3.75), from non-emergency medicine (EM) residents to EM residents (adjusted OR, 2.02; 95% CI, 1.44-2.82), and from non-EM attending physicians to EM attending physicians (adjusted OR, 2.82; 95% CI, 2.14-3.71). Conclusions: In this large multicenter study, rescue interventions were associated with a higher second-attempt success rate. The data also support the use of RSI and backup by EM residents or EM attending physicians to improve the airway management performance after a failed attempt in the ED.

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Repeated attempts at tracheal intubation by a single intubator associated with decreased success rates in emergency departments: an analysis of a multicentre prospective observational study

Abstract: In this large multicentre study of ED patients undergoing tracheal intubation, second attempts at intubation by a single intubator, compared with those by alternate intubators, were independently associated with a decreased success rate.

Cited by 26 publications

References 15 publications

Prospective validation of the modified LEMON criteria to predict difficult intubation in the ED

Prospective validation of the modified LEMON criteria to predict difficult intubation in the ED

Advancing emergency airway management practice and research

Factors associated with successful rescue intubation attempts in the emergency department: an analysis of multicenter prospective observational study in Japan

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