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Assessing Sex Disparities in Rapid Sequence Intubation Procedures in the Emergency Department: Registry Study
Hatem Alkhouri1,2, Isaac Arnold3, Samantha Bennett4
1Emergency Care Institute, Agency for Clinical Innovation, Sydney, Australia.
Emergency Medicine Australasia : EMA
|November 6, 2025
Summary
Males experienced lower first-pass success rates and more complications during rapid sequence intubation (RSI) in emergency departments. Further research is needed to explore sex-aware strategies for improving intubation outcomes.
Area of Science:
- Emergency Medicine
- Anesthesiology
- Critical Care
Background:
- Rapid sequence intubation (RSI) is a critical procedure for emergency airway management.
- Understanding factors influencing RSI success is crucial for patient safety.
Purpose of the Study:
- To investigate sex-based differences in rapid sequence intubation outcomes.
- To explore biological, pharmacological, and psychosocial factors influencing intubation success and complications.
Main Methods:
- Analysis of 5021 intubation episodes from the ANZEDAR study (Australia and New Zealand).
- Stratification of variables including indications, patient factors, and complications by sex.
- Multivariable logistic regression to identify factors associated with first-pass success (FPS) and complications.
Main Results:
- Males had higher rates of trauma intubation, predicted/observed difficult laryngoscopy, lower FPS, and more complications (e.g., desaturation).
- Females had higher rates of medical indications (overdose, stroke) and mainstem bronchus intubation.
- No significant differences in clinical practices (positioning, video laryngoscopy use, staff seniority) were observed despite predicted difficulty differences.
Conclusions:
- Sex-related differences in RSI outcomes were observed, with males experiencing lower FPS and higher complication rates.
- Findings are exploratory; prospective studies are recommended to assess the impact of sex-aware assessment and preparation on RSI outcomes.
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