Factors associated with successful second and third intubation attempts in the ED

The aim of this study was to identify the factors associated with successful second and third attempts in adults following a failed first intubation attempt in the emergency department (ED).

This was a retrospective analysis of the data from a multicenter, prospective, observational airway registry in South Korea. We obtained demographic and clinical data of intubated adult patients in 6 academic EDs from January 2007 to December 2010. The primary outcome was successful rescue attempt, which was defined as the successful placement of an endotracheal tube following a failed first intubation attempt. Logistic regression analyses were conducted to develop a multivariate model identifying factors associated with successful second and third attempts.

Of 5905 adult patients, 1122 (19.0%) failed a first intubation attempt. The success rates of the second and third attempts were 79.2% and 78.5%, respectively. In the multivariate logistic regression analysis, factors associated with a successful second attempt were emergency physicians, senior physicians, nondifficult airway, and the use of a rapid sequence intubation (RSI) (odds ratio = 2.81 [95% confidence interval, 1.80-4.37], 1.50 [1.10-2.07], 2.15 [1.53-3.01], and 1.53 [1.01-2.33], respectively). Nondifficult airway and the use of RSI were associated with successful third attempts (5.48 [2.69-11.18] and 2.63 [1.08-6.40], respectively).

Nondifficult airway and the use of RSI were associated with successful second and third intubation attempts. The use of RSI, backup by experienced senior physicians, and preparation for management of a difficult airway could be strategies for successful rescue intubation attempts in the ED.