Emergency Airway Management: A Look into the Practice, Rate of Success, and Adverse Events of 94 Endotracheal...

Endotracheal intubation in the critically unwell is a life-saving procedure, frequently performed in the emergency department (ED). The 4^th National Audit Project (NAP4) of the Royal College of Anaesthetists and Difficult Airway Society, however, highlighted the deficiencies that could have led to serious harm. In direct response to NAP4, a 2018 guideline was published on the management of intubations in critically ill adults.

This study describes the current practice of endotracheal intubation, in comparison to the published 2018 guideline.

A retrospective observational study in an ED of a district general hospital in Greater London.

Adult attendances from September 1, 2017, to September 1, 2018 (>18 years old) fulfilling the search criteria were reviewed, producing 1553 case notes. These cases were individually reviewed by the authors.

Mann-Whitney U-test.

There were 94 intubations, male to female ratio 1.8:1. The most common indication was for airway protection (n = 35), followed by respiratory failure (n = 23). There were 31 first-pass intubation successes. Intensivists performed most of the intubations (n = 66), followed by anesthetists (n = 13), and ED physicians (n = 10), but with no significant difference between the response rates of ED and external physicians (P = 0.0477). Propofol was the induction drug of choice (n = 37), with rocuronium the paralyzing agent of choice (n = 42). Altogether, there were eight complications reported.

This study provides an overview of the intubation practices in a single-center ED. Non-ED physicians perform the majority of intubations, with a variety of induction and paralyzing agents being used. It adds to the growing call for better standardization and provision of care to patients with a deteriorating airway and the continued auditing of practice.