Emergency Department Use of Airway Adjuncts in the Setting of Endotracheal Intubation for Traumatic Injury

Data on airway adjunct use in emergency department (ED) for trauma resuscitation are limited.

Investigate ED airway adjunct utilization and determine what factors were associated with selection.

We analyzed data from the American College of Surgeons Trauma Quality Improvement Program database for ED endotracheal intubation (ETI) and analyzed concomitant use of supraglottic airway (SGA), nasopharyngeal (NPA), oropharyngeal (OPA), and noninvasive positive pressure ventilation (NIPPV). Bougie use was not available for data query in this database, and prehospital data were excluded.

From 2017 to 2022 there were 6,714,002 encounters, with 236,217 (3.52%) undergoing ETI, of which 15,401 (6.52%) met inclusion for pediatric sub-analysis. Adjuncts were employed in 2389 cases (10%). Median age was 41 years, and 76% were male. Collisions and the thorax were the most common mechanism of injury and injured body segment. Adjuncts were employed in 181 pediatric cases (1.2%). Median age was 14 years and 74% were male. Collisions and the head/neck were the most common mechanism of injury and injured body segment. Overall, NIPPV was used in 1586 (0.67%), NPA in 223 (0.09%), and OPA in 580 (0.25%) cases. Within the pediatric sub-group, NIPPV was used in 118 (0.76%), NPA in 22 (0.14%), and OPA in 41 (0.27%) cases. There was no documented SGA use with a concomitant documented ETI.

Among trauma patients undergoing ETI in the ED, airway adjunct use was rare, and SGA use was not documented in any case. The reasons for low utilization of adjuncts remain unclear.