Successes and failures of ED trauma intubations

Approximately, 12% of trauma activations require intubation and 25% of all emergency department (ED) intubations are in trauma patients. The first-pass success rate in trauma patient intubation is 64-90%. This study aims to explore factors associated with first-pass success and adverse event rates in trauma patients in a Canadian context.

We conducted a health records and registry review of a cohort of trauma patients requiring intubation at two Level 1 trauma sites in British Columbia (January 2017-March 2022). Primary outcome was first-pass success rate. Secondary outcomes were adverse events rates as well as identifying factors associated with first-pass success and adverse events. Multivariate logistic regression explored associations with key covariates and estimated adjusted odds ratios.

Among 440 patients, 85% experienced first-pass success and 22% experienced adverse events. DASH-1A rates were 72%. Adjusted logistic regression revealed that video laryngoscopy was positively associated with first-pass success (OR 2.38 CI 1.13-4.99 p = 0.02). Trauma to head, face, or neck was negatively associated with first-pass success (OR 0.09 CI 0.01-0.65, p = 0.02). Intubations by junior residents and higher injury severity scores were associated with an increased odds ratio of adverse events (OR 2.12 CI 1.02-4.42 p = 0.05 and OR 1.04 CI 1.02-1.06 p = 0.001 respectively).

Our project is the first to comprehensively report first-pass success, adverse events, intubation operator/equipment, and trauma characteristics for Canadian trauma patients intubated in the ED. Video laryngoscopy was associated with improved first-pass success, while head, face, or neck trauma was associated with reduced first-pass success. Further, intubations by junior residents and extensive injuries were found to be associated with a greater frequency of adverse events. Ongoing quality improvement and trauma-specific intubation training should continue in order to improve first-pass success, reduce adverse events, and address patient-oriented outcomes.