Airway registries in primarily adult, emergent endotracheal intubation: a scoping review

Abstract

Background Emergency Department (ED) airway registries are formalized methods to collect and document airway practices and outcomes. Airway registries have become increasingly common in EDs globally; yet there is no consensus of airway registry methodology or intended utility. This review builds on previous literature and aims to provide a thorough description of international ED airway registries and discuss how airway registry data is utilized. Methods A search of Medline, Embase, Scopus, Cochrane Libraries, Web of Science, and Google Scholar was performed with no date limitations applied. English language full-text publications and grey literature from centres implementing an ongoing airway registry to monitor intubations performed in mainly adult patients in an ED setting were included. Non-English publications and publications describing airway registries to monitor intubation practices in predominantly paediatric patients or settings outside of the ED were excluded. Study screening for eligibility was performed by two team members individually, with any disagreements resolved by a third team member. Data was charted using a standardized data charting tool created for this review. Results Our review identified 124 eligible studies from 22 airway registries with a global distribution. We found that airway registry data is used for quality assurance, quality improvement, and clinical research regarding intubation practices and contextual factors. This review also demonstrates that there is a great deal of heterogeneity in definitions of first-pass success and adverse events in the peri-intubation period. Conclusions Airway registries are used as a crucial tool to monitor and improve intubation performance and patient care. ED airway registries inform and document the efficacy of quality improvement initiatives to improve intubation performance in EDs globally. Standardized definitions of first-pass success and peri-intubation adverse events, such as hypotension and hypoxia, may allow for airway management performance to be compared on a more equivalent basis and allow for the development of more reliable international benchmarks for first-pass success and rates of adverse events in the future.

Comparison of induction agents for rapid sequence intubation in refractory status epilepticus: A single-center retrospective analysis

“…Our findings, although exploratory in nature due to a relatively low sample size, are relevant because in recent work examining 124 studies from 22 airway registries worldwide, etomidate is one of the most frequently used induction agents, particularly by emergency medicine physicians who perform over 50 % of intubations for SE in the United States. [2] , [21] Though the use of etomidate specifically in the intubation of patients with SE is not known, routine use is plausible. Indeed, in our study, etomidate was the most used drug for induction.…”