Rapid Intubation Sequence: 4-Year Experience in an Emergency Department

Muñoz, Ángela María; Estrada, Manuela; Quintero, Jaime; Umaña, Mauricio

doi:10.2147/oaem.s321365

Cited by 1 publication

(1 citation statement)

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“…Another recent study from Columbia reported that EM residents only performed 1.3% of intubations, and the remaining were performed by more experienced physicians. This study reported complications in 9% and an FPS of 90.5% [ 13 ]. A multicenter observational study conducted across 11 Irish EDs reported that 90% of intubations were performed by physicians at the registrar level.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Observational Study of Endotracheal Intubation Practices in an Academic Emergency Department of a Tertiary Care Hospital in South India

Tamilarasu¹,

Aazmi²,

Vinayagam³

et al. 2023

Cureus

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Introduction: Airway management is the first critical step to be addressed in the airway, breathing, and circulation algorithm for stabilizing critically ill patients. Since the emergency department (ED) is the primary contact of these patients in health care, doctors in the ED should be trained to perform advanced airway management. In India, emergency medicine has been recognized as a new specialty by the Medical Council of India (now the National Medical Commission) since 2009. Data related to airway management in the ED in India is sparse.Methods: We conducted a one-year prospective observational study to establish descriptive data regarding endotracheal intubations performed in our ED. Descriptive data related to intubation was collected using a standardized proforma that was filled by the physician performing intubation.Results: A total of 780 patients were included, of which 58.8% were intubated in the first attempt. The majority (60.4%) of the intubations were performed in non-trauma patients and the remaining 39.6% in trauma patients. Oxygenation failure was the most common indication (40%) for intubation followed by a low Glasgow coma scale (GCS) score (35%). Rapid sequence intubation (RSI) was performed in 36.9% of patients, and intubation was done with sedation only in 36.9% of patients. Midazolam was the most commonly used drug -either alone or in combination with other drugs. We found a strong association of first-pass success (FPS) with the method of intubation, Cormack-Lehane grading, predicted difficulty in intubation, and experience of the physician performing the first attempt of intubation (P<0.05). Hypoxemia (34.6%) and airway trauma (15.6%) were the most commonly encountered complications. Conclusion: Our study showed an FPS of 58.8%. Complications were seen in 49% of intubations. Our study highlights the areas for quality improvement in intubation practices in our ED, like the use of videolaryngoscopy, RSI, airway adjuncts like stylet and bougie, and intubation by more experienced physicians in patients with anticipated difficult intubation.

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Section: Discussionmentioning

confidence: 99%