Systematic review and meta‐analysis of first‐pass success rates in emergency department intubation: Creating a benchmark for emergency airway care

Abstract

Research published in the last 16 years shows a mean ED FPS rate of 84.1%. This represents the best available published data that can be used to benchmark emergency airway performance.

Emergency airway management in Australian and New Zealand emergency departments: A multicentre descriptive study of 3710 emergency intubations

“…The majority of patients were men, and most had a medical indication for intubation, similar to other studies. 23 We found that ED intubation is not generally challenging because of anatomical difficulty (the majority were CL grade I or II) but likely due to a patient's physiological derangements, disease process and situational urgency. Although a pre-intubation checklist did not favourably influence success or complication rates, we support its use due to the potential to reduce stress and error during this high-risk procedure.…”

“…13,21,22 A reduced first attempt success for trauma patients has also been previously reported. 23 We found that ED intubation is not generally challenging because of anatomical difficulty (the majority were CL grade I or II) but likely due to a patient's physiological derangements, disease process and situational urgency. The complication rate of 26.0% is higher than reported elsewhere.…”

“…The higher proportion of trauma intubations at major referral centres is an expected finding, and due to prevailing pre-hospital diversion policies for major trauma cases in Australasian cities. 23 Other groups have defined desaturation as an oxygen saturation of <90%; 4,10 however, we chose an oxygen saturation of <93% for reasons previously discussed, 12 and in order to provide a margin of safety before critical desaturation occurs. 19,20 Factors associated with improved first attempt success rate included video laryngoscopy, bougie use and a CL grade I or grade II view.…”

Airway registry and training curriculum improve intubation outcomes in the intensive care unit

“…Repeated or prolonged intubation attempts exhaust any physiologic reserve these patients may have, leading to more frequent adverse outcomes (6). Thus, maximizing first attempt success without an adverse event is the goal for airway management in this high-risk population (7,8).…”

Lessons learnt from incidents involving the airway and breathing reported from Australasian emergency departments

“…For 3710 episodes of intubation over 2 years in 38 EDs, there was an intubation rate of approximately 1:500 ED presentations. In a recent meta‐analysis of 16 ED airway papers describing 42 081 episodes of intubation, the cricothyrotomy rate was 0.3%, and the peri‐intubation cardiac arrest rate was 0.6%. Therefore, for any individual ED to identify systems issues from patterns in these very rare, yet potentially catastrophic presentations, would take an unconscionable period of time.…”