Practice and Outcomes of Endotracheal Intubation in the Emergency Department : a retrospective observational study at a single institution in Bhutan

Abstract

Background: Airway management is a critical skill required in the Emergency Department (ED). We conducted an observational airway registry-based study to report the practice and outcome of endotracheal intubations in the ED at a national hospital in Thimphu. Methods: All patients who were intubated in the ED and recorded on the registry data form between May 2020 to November 2022 were studied. Variables such as indications, type of physician performing intubations, success rate, complications, medications, and disposition were captured. Descriptive analysis was presented in frequency and proportions. Results: There were a total of 336 intubations during the study period. First pass success rate was 87.80% and complication rate was 19.64%. 40 patients (11.90%) needed a second attempt and only 1 patient required a third attempt. Most intubations were performed by emergency medicine (EM) residents (54.17%), followed by medical officers (37.8%). Emergency Physician (EP) performed the least number of intubations, 27 (8.04%). 64.5% (n=217) patients received positive pressure ventilations during preoxygenation and 119 (35.42%) did not. Conclusion: Physicians working in the ED are the primary airway provider. First pass success rate was 87.80%. 40 patients (11.90%) needed a second attempt and only 1 patient required a third attempt.