First-Attempt Success Between Anatomically and Physiologically Difficult Airways in the National Emergency Airway...

Area of Science:

• Emergency Medicine
• Anesthesiology
• Critical Care

Background:

• Certain airway characteristics in the emergency department (ED) can increase tracheal intubation complications.
• Anatomically difficult airways (ADAs) and physiologically difficult airways (PDAs) may negatively impact intubation outcomes.

Purpose of the Study:

• To investigate the association between anticipated difficult airways (ADA, PDA, or both) and first-attempt tracheal intubation success in the ED.
• To compare first-attempt success rates between patients with and without difficult airway characteristics.

Main Methods:

• Retrospective observational study using the National Emergency Airway Registry (NEAR) from 2016-2018.
• Included adult ED intubations with sedation and paralysis, excluding cardiac arrest patients.
• Analyzed first-attempt success, success without adverse events, and other outcomes using mixed-effects models.

Main Results:

• ADAs alone were associated with lower first-attempt success (aOR 0.53).
• PDAs alone showed no significant difference in first-attempt success (aOR 0.96).
• Combined ADAs and PDAs significantly reduced first-attempt success (aOR 0.44) and success without adverse events (aOR 0.44).

Conclusions:

• ADAs are inversely associated with first-attempt tracheal intubation success in the ED.
• PDAs alone did not significantly affect first-attempt success.
• Both ADAs and PDAs, individually and combined, were associated with lower rates of successful intubation without adverse events.