First Pass Success Without Adverse Events Is Reduced Equally with Anatomically Difficult Airways and Physiologically...

Area of Science:

• Emergency Medicine
• Anesthesiology
• Critical Care

Background:

• First pass success without adverse events (FPS-AE) is the primary goal of emergency airway management.
• Anatomically difficult airways are known challenges, but the impact of physiologically difficult airways on FPS-AE is less understood.
• This study investigates the combined effects of anatomical and physiological difficulty on FPS-AE during emergency department rapid sequence intubation (RSI).

Purpose of the Study:

• To evaluate the impact of anatomically and physiologically difficult airways on first pass success without adverse events (FPS-AE).
• To compare the effects of anatomical difficulty versus physiological difficulty on intubation outcomes.
• To inform clinical practice regarding airway assessment and management strategies.

Main Methods:

• Prospective analysis of 1513 rapid sequence intubations (RSIs) in an emergency department quality improvement database (2014-2018).
• Patients categorized into four groups based on the presence of anatomical and/or physiological difficult airway characteristics.
• Multivariable logistic regression used to assess the association between difficult airway characteristics and FPS-AE.

Main Results:

• First pass success without adverse events (FPS-AE) was 92.4% in patients without difficult airways.
• FPS-AE decreased to 82.1% with anatomical difficulty and 81.7% with physiological difficulty.
• Patients with both anatomical and physiological difficulty had the lowest FPS-AE (70.9%), with significantly reduced odds ratios for FPS-AE.

Conclusions:

• Both anatomically and physiologically difficult airways similarly reduce first pass success without adverse events (FPS-AE).
• Clinical assessment should include planning for physiological difficulty, akin to anatomical difficulty.
• Further research, including randomized controlled trials, is needed to develop optimization strategies for physiologically difficult airways.