Trends in endotracheal intubation for patients with COVID-19 by emergency physicians

Purpose. Emergency physicians are at risk for infection during invasive procedures, and the respirators can reduce this risk. This study aimed to determine whether endotracheal intubation using direct laryngoscopes affected protection performances of respirators. Methods. A randomized crossover study of 24 emergency physicians was performed. We performed quantitative fit tests using respirators (cup type, fold type without a valve, and fold type with a valve) before and during intubation. The primary outcome was respirators’ fit factors (FF), and secondary outcomes were acceptable protection (percentage of scores above 100 FF [FF%]). Results. 24 pieces of data were analyzed. Compared to fold-type respirator without a valve, FF and FF% values were lower when participants wore a cup-type respirator (200 FF [200-200] versus 200 FF [102.75–200], 100% [78.61–100] versus 74.16% [36.1–98.9]; all P<0.05) or fold-type respirator with a valve (200 FF [200-200] versus 142.5 FF [63.50–200], 100% [76.10–100] versus 62.50% [8.13–100]; all P<0.05). There were no significant differences in intubation time and success rate according to respirator types. Conclusions. Motion during endotracheal intubation using direct laryngoscopes influenced the protective performance of some respirators. Therefore, emergency physicians should identify and wear respirators that provide the best personalized fit for intended tasks.

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438: Successful Endotracheal Intubation by Experienced Emergency Physicians Using Direct and Glidescope® Laryngoscopes

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2009.06.478 ◽

2009 ◽

Vol 54 (3) ◽

pp. S138

Author(s):

D. Drigalla ◽

J. Brown ◽

R. Bollinger ◽

C. Rush ◽

D. Kjar ◽

...

Keyword(s):

Endotracheal Intubation ◽

Emergency Physicians

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Analysis of prehospital endotracheal intubation performed by emergency physicians: retrospective survey of a single emergency medical center in Japan

Journal of Anesthesia ◽

10.1007/s00540-012-1528-x ◽

2012 ◽

Vol 27 (3) ◽

pp. 374-379 ◽

Cited By ~ 10

Author(s):

Kei Kamiutsuri ◽

Ryu Okutani ◽

Shuichi Kozawa

Keyword(s):

Endotracheal Intubation ◽

Medical Center ◽

Emergency Physicians ◽

Retrospective Survey ◽

Emergency Medical ◽

Prehospital Endotracheal Intubation

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Endotracheal intubation using a GlideScope video laryngoscope by emergency physicians: a multicentre analysis of 345 attempts in adult patients

Emergency Medicine Journal ◽

10.1136/emj.2009.073460 ◽

2010 ◽

Vol 27 (5) ◽

pp. 380-382 ◽

Cited By ~ 31

Author(s):

H. J. Choi ◽

H. G. Kang ◽

T. H. Lim ◽

H. S. Chung ◽

J. Cho ◽

...

Keyword(s):

Endotracheal Intubation ◽

Video Laryngoscope ◽

Adult Patients ◽

Emergency Physicians ◽

Glidescope Video Laryngoscope

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Airway managed by emergency physicians or anaesthesiologists in trauma patients: A retrospective cohort analysis of outcomes

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920931719 ◽

2020 ◽

pp. 102490792093171

Author(s):

Tsz Ha Tang ◽

Marc LC Yang ◽

On Yee Chan ◽

Lily PS Chan ◽

Hiu Fai Ho

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Endotracheal Intubation ◽

Statistical Tests ◽

Stepwise Logistic Regression ◽

Trauma Patients ◽

Emergency Physicians ◽

All Cause Mortality ◽

Secondary Outcomes ◽

Post Intubation

Objectives: In some trauma centres, anaesthesiologists have the primary responsibility of managing airway in trauma resuscitation. However, as emergency physicians establish a separate specialty with airway management and endotracheal intubation being one of the core skills, role delineation within trauma members may vary. In this cohort study, we aim to determine the difference in mortality of trauma patients requiring intubation in the emergency department between emergency physicians and anaesthesiologists. Methods: We screened all 1588 patients in the hospital trauma registry from 2015 to 2018. We included all patients requiring endotracheal intubation and aged 18 or above but excluded those with pregnancy, presented with cardiac arrest and secondarily transferred from other hospitals. A total of 349 eligible patients were sorted into two cohorts according to the physicians who performed intubations (anaesthesiologists = 205 patients, emergency physicians = 144 patients). Patients’ baseline demographics, 30-day all-cause mortality and other predefined secondary outcomes were compared by statistical tests. Stepwise logistic regression of 30-day all-cause mortality was performed. Results: Our study has shown that intubation by emergency physicians was not associated with higher 30-day all-cause mortality after potential confounders were controlled by logistic regression (adjusted odds ratio = 1.253, p = 0.607). Both groups also did not differ in other clinical important secondary outcomes, including proportion of successful intubations, use of surgical airway or rescue manoeuvres, respiratory and airway complications, mortality in intensive care or high-dependency unit, post-intubation cardiac arrest, post-intubation hypotension and post-intubation hypoxia. Conclusion: Endotracheal intubation by emergency physicians is not associated with increased 30-day all-cause mortality when compared to anaesthesiologists after accounting for confounders.

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Endotracheal Intubation in Patients With COVID-19 By Emergency Physicians in The Tokyo Metropolitan Area

10.21203/rs.3.rs-181495/v1 ◽

2021 ◽

Author(s):

Mitsuhito Soh ◽

Toru Hifumi ◽

Norio Otani ◽

Momoyo Miyazaki ◽

Kentaro Kobayashi ◽

...

Keyword(s):

Success Rate ◽

Endotracheal Intubation ◽

Metropolitan Area ◽

Patient Characteristics ◽

Emergency Physicians ◽

Related Factors ◽

Tokyo Metropolitan ◽

Tokyo Metropolitan Area ◽

Intubation Success ◽

Intubation Success Rate

Abstract Background: Patients with COVID-19 may require emergency tracheal intubation for mechanical ventilation by emergency physicians. However, the success rate, complications, operator safety, and issues around personal protective equipment (PPE) and barrier enclosure use are not known in this context.Methods: This was a retrospective study of data for adult patients with COVID-19 who underwent endotracheal intubation performed by emergency physicians at four hospitals in the Tokyo Metropolitan Area between January 2020 and September 2020. Patient characteristics, intubation-related factors, and intubation success and complications rates were obtained. Two analyses were then performed. In analysis 1, the intubation success rate in patients was compared among four groups using different types of PPE. In analysis 2, patients were compared by those intubated with or without barrier enclosure.Results: In total, 46 patients met the inclusion criteria, of whom 85% were successfully intubated at the first attempt, 27% experienced hypotension, and 27% experienced hypoxia. No muscle relaxants were used in 8.7% and the Macintosh blade was used in 37%. The four PPE types and the intubation confirmation methods varied considerably, but all met the WHO recommendations. A barrier enclosure device was used in 26%, with a success rate of approximately 80% irrespective of its use.Conclusions: The success rate at the first attempt of intubation was relatively high, albeit with a moderately high complication rate. All PPE types were safe, including when barrier enclosures were used. Success was not affected by using barrier enclosures.

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Prioritising intubator safety in a pandemic: the details matter

Emergency Medicine Journal ◽

10.1136/emermed-2020-210362 ◽

2021 ◽

pp. emermed-2020-210362

Author(s):

Ryan Barnicle ◽

Alexander Bracey ◽

Bassam Zahid ◽

Alexandra Davic ◽

Scott Weingart

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Healthcare Worker ◽

Endotracheal Intubation ◽

Level Of Detail ◽

Worker Safety ◽

The Novel ◽

Emergency Physicians ◽

Respiratory Therapists

Our ED-intensive care unit has instituted a new protocol meant to maximise the safety of physicians, nurses and respiratory therapists involved with endotracheal intubation of patients known or suspected of being infected with the novel SARS-CoV-2. The level of detail involved with this checklist is a deviation from standard intubation practices and is likely unfamiliar to most emergency physicians. However, the two-person system used in our department removes the cognitive burden such complexity would otherwise demand and minimises the number of participants that would typically be exposed during endotracheal intubation. We share this checklist to demonstrate to other departments how adopting international airway guidelines to a specific institution can be achieved in order to promote healthcare worker safety.

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Airway managed by emergency physicians or anaesthesiologists in trauma patients: A retrospective cohort analysis of outcomes

10.21203/rs.3.rs-29500/v1 ◽

2020 ◽

Author(s):

Cathy Tang ◽

Marc L.C. Yang ◽

Annie Chan ◽

Paul H.F. Ho

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Endotracheal Intubation ◽

Statistical Tests ◽

Stepwise Logistic Regression ◽

Trauma Patients ◽

Emergency Physicians ◽

All Cause Mortality ◽

Secondary Outcomes ◽

Post Intubation

Abstract Objectives In some trauma centres, anaesthesiologists (AN) has the primary responsibility of managing airway in trauma resuscitation. However, as emergency physicians(EP) establishes a separate specialty with airway management and endotracheal intubation being one of the core skills, role delineation within trauma members may vary. In this cohort study, we aim to determine the difference in mortality of trauma patients requiring intubation in the Emergency Department between EP and AN. Methods We screened all 1588 patients in the hospital trauma registry from 2015 to 2018. We included all patients requiring endotracheal intubation and aged 18 or above but excluded those with pregnancy, presented with cardiac arrest and secondarily transferred from other hospitals. 349 eligible patients were sorted into two cohorts according to the physicians who performed intubations (AN 205 patients, EP 144 patients). Patients' baseline demographics, 30-day all-cause mortality, and other predefined secondary outcomes were compared by statistical tests. Stepwise logistic regression of 30-day all-cause mortality were performed. Results Our study has shown that intubation by emergency physicians was not associated with higher 30-day all-cause mortality after potential confounders were controlled by logistic regression. (adjusted OR 1.253, p = 0.607) Both group also did not differ in other clinical important secondary outcomes, including proportion of successful intubations, use of surgical airway or rescue manoeuvres, respiratory and airway complications , mortality in intensive care or high-dependency unit, post-intubation cardiac arrest , post-intubation hypotension and post-intubation hypoxia. Conclusion Endotracheal intubation by EP is not associated with increased 30-day all-cause mortality when compared to AN after accounting for confounders.

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