Airway Management by US and Canadian Emergency Medicine Residents: A Multicenter Analysis of More Than 6,000 Endotracheal Intubation Attempts

Sagarin, Mark J.; Barton, Erik D.; Chng, Yi-Mei; Walls, Ron M.

doi:10.1016/j.annemergmed.2005.01.009

Cited by 319 publications

(294 citation statements)

References 16 publications

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“…First-pass success rates in pediatric emergent intubation vary from 37% to 78%, and rates of adverse events are reported to be as high as 61%. [1][2][3] Video laryngoscopy has been demonstrated to improve first-pass and ultimate success and decrease iatrogenic airway trauma during endotracheal intubation in adults. [4][5][6] In addition to clinical benefit, the ability to review videos captured during laryngoscopy provides a unique opportunity to assess metrics related to procedural performance and quality of care.…”

Section: Resultsmentioning

confidence: 99%

Using Video‐recorded Laryngoscopy to Evaluate Laryngoscopic Blade Approach and Adverse Events in Children

Green-Hopkins

Werner

Monuteaux

et al. 2015

Academic Emergency Medicine

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Objectives: Using recordings of endotracheal intubation attempts obtained with a video-enabled laryngoscope with Miller and Macintosh blades, the authors sought to evaluate the association between laryngoscopic approach (right-sided vs. midline) and intubation success, as well as adverse event rates in the pediatric emergency department (ED).Methods: This was a retrospective cohort study of children younger than 21 years who underwent endotracheal intubation with a C-MAC video laryngoscope in a tertiary care ED between August 2009 and May 2013. The primary outcome was successful endotracheal intubation on the first attempt. The secondary outcomes included time to intubation, video-recorded adverse events (oropharyngeal mucosal injury and aspiration), and physiologic adverse events. Multivariate regression models were used to determine the relationship between laryngoscope blade position and outcome measures adjusted for patient and provider factors.Results: The cohort consisted of complete video recordings for 105 of 143 (73%) patient encounters with intubations. The first-pass success rate did not significantly differ based on laryngoscopic approach (adjusted odds ratio [aOR] = 0.76, 95% confidence interval [CI] = 0.29 to 2.0). Among patients successfully intubated on the first attempt, the median time to intubation was longer for the right-sided approach compared to the midline approach (42 seconds vs. 31.5 seconds; p < 0.05). The odds of mucosal injury and aspiration were higher among patients intubated using a right-sided approach compared to a midline approach (aOR = 4.1, 95% CI = 1.2 to 14.5; aOR = 7.7, 95% CI = 1.5 to 39.5, respectively). Rates of physiologic adverse events did not differ based on approach.Conclusions: First-pass success rate did not differ based upon laryngoscopic approach type; however, a right-sided approach was associated with a longer time to intubation, as well as higher rates of mucosal injury and aspiration among patients undergoing video-enabled intubation in a pediatric ED.

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Section: Resultsmentioning

confidence: 99%

Using Video‐recorded Laryngoscopy to Evaluate Laryngoscopic Blade Approach and Adverse Events in Children

Green-Hopkins

Werner

Monuteaux

et al. 2015

Academic Emergency Medicine

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“…Our study revealed that four of 554 trauma patients (0.72%) received ESA in emergency surgery settings (odds ratio: 28.9-144.1). In the field of emergency medicine, studies have found that 0.3-0.9% of trauma patients received CTY in pre-hospital or ER settings [3][4][5][6]. Severe facial injury patients received ESA more often than did patients with other types of trauma.…”

Section: Discussionmentioning

confidence: 99%

Surgical airways for trauma patients in an emergency surgical setting: 11 years’ experience at a teaching hospital in Japan

Ono¹,

Yokoyama²,

Matsumoto³

et al. 2013

J Anesth

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Purpose Airway management of trauma patients during emergency surgeries can be very difficult, and presents a challenge for anesthesiologists. Difficult airways are associated with emergency surgical airways (ESA), but little is known about ESA in the operating room. We conducted this study to clarify the present use of ESA for trauma patients in emergency surgery settings. MethodsWe performed a retrospective review of all trauma patients requiring emergency surgery under general anesthesia at our hospital from January 2002 to December 2012, and focused on ESA.Results During the study period, 15,654 trauma patients were treated at our hospital, of whom 554 (3.5%) required emergency surgery. Four of these (0.72%) received ESA as definitive airway management. Two patients with severe facial injury and distorted upper airways and one patient with penetrating neck trauma received open standard tracheostomies (OST). These three patients received OST as the initial approach to intubation. A fourth OST was performed after several unsuccessful attempts at endotracheal intubation. No cases were classified as "cannot ventilate, cannot intubate" (CVCI), and there were no complications associated with ESA. All cases had good outcomes.Statistical analysis revealed that patients with severe facial trauma (Abbreviated Injury Scale ≥ 3) received ESA at a significantly higher rate than others (p=0.015, Odds ratio: 14.1). ConclusionOne of the most important functions of anesthesiologists is risk management. We should recognize risks that can cause CVCI situations, and make proper clinical decisions, including 3 providing ESA, to assure patient safety.4

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“…Today's wards and critical care units are staffed with doctors with less experience and reduced exposure to difficult airways. This is due to numerous factors including a reduction in the number of difficult airways that present late, shorter working hours, better airway equipment, increased use of supraglottic airways and a reduction in training opportunities [54,59,[128][129][130][131][132][133][134]. It is essential that frontline medical, nursing and allied health staff are competent to manage and assist with tracheostomy and other related airway emergencies if they work in a relevant clinical area [31,38,53,[135][136][137][138][139][140].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies

et al. 2012

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SummaryAdult tracheostomy and laryngectomy airway emergencies are uncommon, but do lead to significant morbidity and mortality. The National Tracheostomy Safety Project incorporates key stakeholder groups with multi‐disciplinary expertise in airway management. , the Intensive Care Society, the Royal College of Anaesthetists, ENT UK, the British Association of Oral and Maxillofacial Surgeons, the College of Emergency Medicine, the Resuscitation Council (UK) the Royal College of Nursing, the Royal College of Speech and Language Therapists, the Association of Chartered Physiotherapists in Respiratory Care and the National Patient Safety Agency. Resources and emergency algorithms were developed by consensus, taking into account existing guidelines, evidence and experiences. The stakeholder groups reviewed draft emergency algorithms and feedback was also received from open peer review. The final algorithms describe a universal approach to managing such emergencies and are designed to be followed by first responders. The project aims to improve the management of tracheostomy and laryngectomy critical incidents.

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Airway Management by US and Canadian Emergency Medicine Residents: A Multicenter Analysis of More Than 6,000 Endotracheal Intubation Attempts

Cited by 319 publications

References 16 publications

Using Video‐recorded Laryngoscopy to Evaluate Laryngoscopic Blade Approach and Adverse Events in Children

Using Video‐recorded Laryngoscopy to Evaluate Laryngoscopic Blade Approach and Adverse Events in Children

Surgical airways for trauma patients in an emergency surgical setting: 11 years’ experience at a teaching hospital in Japan

Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies

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