Trauma airway management in the emergency department: A comparison of first-Pass success rate, indications, and cricothyrotomy by specialty

1999 ◽  
Vol 34 (4) ◽  
pp. S14-S15
Author(s):  
Kulkami RG ◽  
Gurr DE ◽  
Walls RM
Keyword(s):  
Emergency Department ◽  
Airway Management ◽  
Success Rate ◽  
First Pass

scholarly journals Endotracheal Intubations in Emergency Department: A Clinical Audit at a Tertiary Health Centre in South India

2021 ◽  
Vol 5 (2) ◽  
pp. 842-848
Author(s):  
Linu SM ◽  
Roopasree Sivam ◽  
Nikhil Paul ◽  
Mathen P George ◽  
Suresh Babu
Keyword(s):  
Emergency Department ◽  
Airway Management ◽  
Success Rate ◽  
Health Centre ◽  
Dental Trauma ◽  
Rapid Sequence Intubation ◽  
P Value ◽  
Success Rates ◽  
Management Skills ◽  
Cross Sectional

Background: Endotracheal intubation in the emergency department is challenging. Hence, regular audits can help us improve our critical airway management skills. Our study aimed to evaluate the practice of endotracheal intubations performed in the emergency department. Materials and Methods: A retrospective cross-sectional study was conducted among the patients intubated in our teaching hospital's emergency department. The study period was from November 1, 2019, to August 31, 2020. We analyzed first attempt success rates, drug use, indication, and complications. Results: We analysed 90 endotracheal intubations, out of which 70(77.8%) were performed by emergency physicians and 20(22.2%) by anaesthetists. The first attempt success rate was 81.11% (n=73) and had significant differences between the both departments. (p value= 0.003,  χ2= 7.48). More patients had medical indications compared to trauma for intubation (n=88 vs n=32) among which respiratory failure (n=25, 27.78%) was the most common indication. Rapid Sequence Intubation( RSI) adherence was 82.22% (n=74). Lignocaine (n=16, 19.75%), etomidate (n=35, 43.2%) and succinylcholine (n=65, 80.25%) were the commonly used drugs for premedication, induction and as relaxants respectively. 17(18.89%) out of 90 intubation had complications. Desaturation (n=10, 11.11%), bradycardia (n=1, 1.11%), hypotension (n=4, 44%), dental trauma (n=5, 5.55%) and oesophageal intubation (n=3, 3.33%) were observed in our study. Conclusion: Our study is the first  from India which describes the characteristics of endotracheal intubations done in the Emergency Department along with data on RSI adherence. The first attempt success rate, indications, and complications were comparable with other studies in the literature. We recommend future prospective studies to analyze success rates between different specialties and resident doctors to improve the airway management skills in the Department

scholarly journals The Success Rate of Endotracheal Intubation in the Emergency Department of Tertiary Care Hospital in Ethiopia, One-Year Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ayalew Zewdie ◽  
Dejene Tagesse ◽  
Selam Alemayehu ◽  
Tesfaye Getachew ◽  
Menbeu Sultan
Keyword(s):  
Emergency Department ◽  
Success Rate ◽  
Endotracheal Intubation ◽  
Addis Ababa ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Rapid Sequence Intubation ◽  
Care Hospital ◽  
Success Rates ◽  
First Pass

Background. Emergency medical care starts with airway assessment and intervention management. Endotracheal intubation is the definitive airway management in the emergency department (ED) for patients requiring a definitive airway. Successful first pass is recommended as the main objective of emergency intubation. There exists no published research regarding the success rates or complications that occur within Ethiopian hospitals emergency department intubation practice. Objective. This study aimed to assess the success rate of emergency intubations in a tertiary hospital, Addis Ababa, Ethiopia. Methodology. This was a single institute retrospective documentation review on intubated patients from November 2017 to November 2018 in the emergency department of Addis Ababa Burn Emergency and Trauma Hospital. All intubations during the study period were included. Data were collected by trained data collectors from an intubation documentation sheet. Result. Of 15,933 patients seen in the department, 256 (1.6%) patients were intubated. Of these, 194 (74.9%) were male, 123 (47.5%) sustained trauma, 65 (25.1%) were medical cases, and 13(5%) had poisoning. The primary indications for intubation were for airway protection (160 (61.8%)), followed by respiratory failure (72(27.8%)). One hundred and twenty-nine (49.8%) had sedative-only intubation, 110 (42.5%) had rapid sequence intubation, and 16 (6.2%) had intubation without medication. The first-pass success rate in this sample was 70.3% (180/256), second-pass 21.4% (55/256), and third-pass 7.4% (19/256), while the overall success rate was 99.2% (254/256). Hypoxia was the most common complication. Conclusion. The intubation first-pass success rate was lower than existing studies, but the overall intubation success rate was satisfactory.

scholarly journals Does Video Laryngoscopy or Direct Laryngoscopy affect first pass success rates for intubation among Attending and Non-Attending Emergency Physician in the Emergency Department?

2019 ◽  
Author(s):  
Paul Weng Wan ◽  
Zakaria Nur Diana ◽  
Seow Gek Ching ◽  
Wong Evelyn
Keyword(s):  
Emergency Department ◽  
Success Rate ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy ◽  
Secondary Outcome ◽  
Emergency Physicians ◽  
Success Rates ◽  
Direct Laryngoscope ◽  
First Pass ◽  
Lemon Score

Abstract Background: To our knowledge, there has been no study comparing intubation characteristics between attending and non-attending Emergency Physicians in South-East Asia. We aim to identify whether the use of Direct Laryngoscopy (DL) compared to Video Laryngoscopy (VL) affects first pass success rates between Attending Emergency Physicians (AEP) and Non-Attending Emergency Physicians (NAEP). Materials and Methods: Retrospective analysis of data from 2009 to 2016 in an existing airway registry managed by and academic Emergency Department in Singapore. Primary outcome is first pass success intubation rate. The secondary outcome was first pass success rate for difficult intubations. Difficult intubations were defined as LEMON score of more than 1 or more than 1 attempt at intubation. Results: There were 2909 intubation carried out by emergency physicians in the Emergency Department from 2009 to 2016. AEP conducted 1748 intubations while NAEP conducted 1161 intubations. The first pass success rates for AEP was 84.2% while that for NAEP was 67.4%. 86.2% of intubations by AEP were done with a direct laryngoscope. 89.0% of the intubations by NAEP were done with a direct laryngoscope. 18.9% of intubations by the AEP were difficult compared to 35.2% by the NAEP (p<0.01 95% C.I 13.0%-19.6%). First pass success rate with VL was lower than DL for all intubations (OR 0.66, 95% C.I 0.51-0.84). In the subgroup of difficult intubations, VL did not improve first pass success rate among AEP (OR 0.77, 95% C.I 0.38-1.58) but it did for NAEP (OR 2.46, 95% C.I 0.94-6.45). Conclusion: Our study showed that VL has a poorer first pass success rate for all intubations in general. However, specifically for difficult intubations, VL is associated with improved first pass success rates among NAEP.

Management & complications of airway in COVID-19 suspected & confirmed cases: a retrospective cohort study

2021 ◽  
Vol 15 (8) ◽  
pp. 1838-1841
Author(s):  
Almas Iqbal ◽  
Huma Saleem ◽  
Noshin Akram
Keyword(s):  
Airway Management ◽  
Success Rate ◽  
Tertiary Care ◽  
Single Agent ◽  
Inclusion Criteria ◽  
Out Of Hours ◽  
Institutional Review ◽  
First Pass ◽  
Ethical Approval ◽  
Minimum Number

Background: The outbreak of COVID-19 in Pakistan started from February 2020 and over the next few months it affected around a million people, leaving thousands dead in an already burdened healthcare infrastructure. Rising to the challenge of COVID 19 airway management, we adopted components of ‘Consensus guidelines for managing airways in patients with COVID 19 to improve success of first pass intubation alongwith minimising risk of infection to self and others. Aim: To analyse the techniques of airway management and complications of suspected or confirmed COVID status at time of their airway management. Methodology: After ethical approval by the institutional review board, data is collected from the Hospital Information System (HIS) for cases fulfilling inclusion criteria, from April to September 2020 in a tertiary care cancer hospital, Pakistan. Results: In our centre, forty-five intubations were performed, 71% of these intubations were out of hours and 43% performed by consultants. It had a high 1st attempt success rate of 84.4%, using Videolaryngoscope (64.4%) and 55.6% confirmed use of capnography. In all cases (100%) PPE was available and used. Minimum number of personnel in room during intubation was kept to four to five in 55.6% of cases. Conclusion: Dedicated airway team used Personal Protective Equipment in all cases (100%) and restricted the number of personnel during the procedure. A high success rate of 1st attempt intubation, widely used videolaryngoscope, single agent induction and consultant intubators were salient features of our practice. Keywords: Keywords: Airway, Covid 19, Intubation, Pakistan

scholarly journals Difficult airway predictors were associated with decreased use of neuromuscular blocking agents in emergency airway management: a retrospective cohort study in Thailand

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jutamas Saoraya ◽  
Komsanti Vongkulbhisal ◽  
Norawit Kijpaisalratana ◽  
Suthaporn Lumlertgul ◽  
Khrongwong Musikatavorn ◽  
...  
Keyword(s):  
Emergency Department ◽  
Airway Management ◽  
Difficult Airway ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Blocking Agents ◽  
Glottic View ◽  
First Pass

Abstract Background It is recommended that difficult airway predictors be evaluated before emergency airway management. However, little is known about how patients with difficult airway predictors are managed in emergency departments. We aimed to explore the incidence, management and outcomes of patients with difficult airway predictors in an emergency department. Methods We conducted a retrospective study using intubation data collected by a prospective registry in an academic emergency department from November 2017 to October 2018. Records with complete assessment of difficult airway predictors were included. Two categories of predictors were analyzed: predicted difficult intubation by direct laryngoscopy and predicted difficult bag-mask ventilation. The former was evaluated based on difficult external appearance, mouth opening and thyromental distance, Mallampati score, obstruction, and limited neck mobility as in the mnemonic “LEMON”. The latter was evaluated based on difficult mask sealing, obstruction or obesity, absence of teeth, advanced age and reduced pulmonary compliance as in the mnemonic “MOANS”. The incidence, management and outcomes of patients with these difficult airway predictors were explored. Results During the study period, 220 records met the inclusion criteria. At least 1 difficult airway predictor was present in 183 (83.2%) patients; 57 (25.9%) patients had at least one LEMON feature, and 178 (80.9%) had at least one MOANS feature. Among patients with at least one difficult airway predictor, both sedation and neuromuscular blocking agents were used in 105 (57.4%) encounters, only sedation was used in 65 (35.5%) encounters, and no medication was administered in 13 (7.1%) encounters. First-pass success was accomplished in 136 (74.3%) of the patients. Compared with patients without predictors, patients with positive LEMON criteria were less likely to receive neuromuscular blocking agents (OR 0.46 (95% CI 0.24–0.87), p = 0.02) after adjusting for operator experience and device used. There were no significant differences between the two groups regarding glottic view, first-pass success, or complications. The LEMON criteria poorly predicted unsuccessful first pass and glottic view. Conclusions In emergency airway management, difficult airway predictors were associated with decreased use of neuromuscular blocking agents but were not associated with glottic view, first-pass success, or complications.

scholarly journals Does video laryngoscopy or direct laryngoscopy affect first-pass success rates for intubation among attending and non-attending emergency physicians in the emergency department?

2020 ◽  
pp. 102490792091063
Author(s):  
Wan Paul Weng ◽  
Nur Diana Bte Zakaria ◽  
Seow Gek Ching ◽  
Evelyn Wong
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Success Rate ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy ◽  
Secondary Outcome ◽  
Emergency Physicians ◽  
Success Rates ◽  
Mallampati Score ◽  
First Pass

Background: To our knowledge, there has been no study comparing intubation characteristics between attending and non-attending emergency physicians in Southeast Asia. We aim to identify whether the use of direct laryngoscopy compared to video laryngoscopy affects first-pass success rates between attending emergency physicians and non-attending emergency physicians. Materials and methods: Retrospective analysis of data from 2009 to 2016 in an existing airway registry managed by an academic Emergency Department in Singapore. Primary outcome was first-pass success intubation rate. Secondary outcome was first-pass success rate for difficult intubations. Difficult intubations were defined as LEMON (Look externally, Evaluate 3-3-2 rule, Mallampati score, Obstruction, Neck mobility) score of more than 1. Results: There were a total of 2909 intubations. Attending emergency physicians conducted 1748 intubations, while non-attending emergency physicians conducted 1161 intubations. The first-pass success rates for AEP were 84.2% and 67.4% for non-attending emergency physicians. Direct laryngoscopy was used in 86.2% of intubation by attending emergency physicians compared to 89.0% in the intubation by non-attending emergency physicians. Also, 7.6% of intubations by the attending emergency physicians were difficult compared to 8.8% by the non-attending emergency physicians (p = 0.25). Logistic regression of the effect of laryngoscopy device on first-pass success in all intubations showed a negative association with video laryngoscopy (odds ratio, 0.70; 95% confidence interval, 0.56–0.88). In the subgroup of difficult intubations, non-attending emergency physicians are 1.54 times (95% confidence interval, 0.53–4.42) as likely to have first-pass success with video laryngoscopy compared to that with direct laryngoscopy. On the contrary, in the subgroup of difficult intubations, attending emergency physicians are 0.90 times (95% confidence interval, 0.38–2.12) as likely to have first-pass success with video laryngoscopy compared to that with direct laryngoscopy. Conclusion: Our study showed that video laryngoscopy has a lower first-pass success rate for all intubations in general. Intubations performed by attending emergency physicians with direct laryngoscopy were associated with a higher first-pass success rate.

Improving first-pass success rates during emergency intubation at an academic emergency department: a quality improvement initiative

2021 ◽  
Vol 33 (3) ◽  
Author(s):  
Abdullah Bakhsh ◽  
Ahd Alharbi ◽  
Raghad Almehmadi ◽  
Sara Kamfar ◽  
Arwa Aldhahri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Airway Management ◽  
Performance Monitoring ◽  
Video Laryngoscopy ◽  
Rapid Sequence Intubation ◽  
Quality Improvement Initiative ◽  
Success Rates ◽  
Improvement Program ◽  
First Pass

Abstract Background Airway management is a high-stakes procedure in emergency medicine. Continuously monitoring this procedure allows performance improvement while revealing safety issues. We instituted a quality improvement initiative in the emergency department to improve first-pass success rates in the emergency department. Methods This was a quality improvement initiative at an academic emergency department from 2018 to 2020. We developed a rapid sequence intubation guideline for procedure standardization and introduced an intubation procedure note for performance monitoring. Data were entered directly by the primary physician and nurse during intubation. The quality improvement team thereafter collected the data retrospectively and entered into a local airway database. More importantly, we introduced a culture of quality improvement and safety in airway management via regular education and feedback. Results We included a total of 146 intubations. The first-pass success rate started at 57.1% and increased to 80.0% during the study period (P &lt; 0.01). Fifty-six percent were male, and the mean age (±SD) was 55.56 (±17.64). Video laryngoscopy was used in 101 (69.2%) patients, while direct laryngoscopy was used in only 44 (30.8%) patients. A logistic regression analysis was conducted to determine the independent factors associated with first-pass success. These factors included the use of video laryngoscopy (odds ratio (OR) 2.47 95% confidence interval (95% CI) [1.62–3.76]) (adjusted OR 3.87 [1.13–13.23]) and good Cormack–Lehane views (grades 1–2) (OR 2.71 95% CI [1.74–4.20]) (adjusted OR 7.88 [2.43–25.53]). Conclusion Our study shows that implementing and maintaining an airway quality improvement program improves first-pass intubation success. Moreover, the use of video laryngoscopy and obtaining good Cormack–Lehane views (grades 1–2) are independently associated with improved first-pass success.

Impact of a targeted bundle of audit with tailored education and an intubation checklist to improve airway management in the emergency department: an integrated time series analysis

2020 ◽  
Vol 37 (9) ◽  
pp. 576-580
Author(s):  
Christopher Groombridge ◽  
Amit Maini ◽  
Alexander Olaussen ◽  
Yen Kim ◽  
Mark Fitzgerald ◽  
...  
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Adverse Events ◽  
Time Series Analysis ◽  
Airway Management ◽  
Success Rate ◽  
Intervention Group ◽  
Quality Improvement Initiative ◽  
Series Analysis ◽  
Major Trauma Centre

BackgroundEndotracheal intubation (ETI) is a commonly performed but potentially high-risk procedure in the emergency department (ED). Requiring more than one attempt at intubation has been shown to increase adverse events and interventions improving first-attempt success rate should be identified to make ETI in the ED safer. We introduced and examined the effect of a targeted bundle of airway initiatives on first-attempt success and adverse events associated with ETI.MethodsThis prospective, interventional cohort study was conducted over a 2-year period at an Australian Major Trauma Centre. An online airway registry was established at the inception of the study to collect information related to all intubations. After 6 months, we introduced a bundle of initiatives including monthly audit, monthly airway management education and an airway management checklist. A time series analysis model was used to compare standard practice (ie, first 6 months) to the postintervention period.ResultsThere were 526 patients, 369 in the intervention group and 157 in the preintervention comparator group. A total of 573 intubation attempts were performed. There was a significant improvement in first-attempt success rates between preintervention and postintervention groups (88.5% vs 94.6%, relative risk 1.07; 95% CI 1.00 to 1.14, p=0.014). After the introduction of the intervention the first-attempt success rate increased significantly, by 13.4% (p=0.006) in the first month, followed by a significant increase in the monthly trend (relative to the preintervention trend) of 1.71% (p<0.001). The rate of adverse events were similar preintervention and postintervention (hypoxia 8.3% vs 8.9% (p=0.81); hypotension 8.3% vs 7.0% (p=0.62); any complication 27.4% vs 23.6% (p=0.35)).ConclusionsThis bundle of airway management initiatives was associated with significant improvement in the first-attempt success rate of ETI. The introduction of a regular education programme based on the audit of a dedicated airway registry, combined with a periprocedure checklist is a worthwhile ED quality improvement initiative.

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