Intubation Practices in Community Emergency Departments

Area of Science:

• Emergency Medicine
• Critical Care
• Anesthesiology

Background:

• Airway management is a critical skill in emergency medicine.
• Understanding trends in emergency airway management is crucial for improving patient outcomes.

Purpose of the Study:

• To analyze trends and outcomes of emergency medicine airway management in community emergency departments.
• To compare these trends with those observed in academic Level-1 trauma centers.

Main Methods:

• A multicenter, retrospective chart review of 11,475 intubations.
• Data collected from January 1, 2015, to December 31, 2022.
• Included patient demographics, medications, intubation techniques, diagnoses, and mortality rates.

Main Results:

• Rocuronium use increased from 33.9% to 61.9%; video laryngoscopy use increased from 27.4% to 77.7%.
• First-pass success rate was 80.5%, with a 0.2% failure rate.
• High all-cause mortality rates observed: 19.7% at 24 hours, 45.4% at 1 year.

Conclusions:

• Community ED physicians achieve first-pass success rates similar to academic centers.
• Significant shifts in paralytic agent and intubation method choices were observed.
• Patients treated in community EDs face high mortality rates despite comparable intubation success.