Association between Difficult Airway Predictors and Failed Prehosptial Endotracheal Intubation

Joshua B Gaither, Uwe Stolz, Joshua Ennis, Jarrod Moiser, John C. Sakles

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective Difficult airway predictors (DAPs) are associated with failure of endotracheal intubation (ETI) in the emergency department (ED). The purpose of this study was to determine if DAPs are associated with failure of prehospital ETI. Methods This retrospective study compared the prevalence of DAPs in cases of failed prehospital ETI successfully intubated in the ED (FPH/SED) with cases with no prehospital attempt that were successfully intubated in the ED on the first attempt by a physician using direct laryngoscopy (NPH/SED). All cases were transported by ground or air to an academic, level-1 trauma center. Results A total of 1377 ED ETIs were performed; 161 FPH/SED and 530 NPH/SED were identified. The odds ratios with 95% confidence intervals (CIs) of finding DAPs in the FPH/SED group compared with the NPH/SED group was blood = 5.80 (95% CI, 3.89-8.63), vomit = 2.01 (95% CI, 1.25-3.21), short neck = 2.67 (95% CI, 1.39-5.03), neck immobility = 2.52 (95% CI, 1.72-3.67), airway edema = 10.52 (95% CI, 4.15-29.92), facial trauma = 4.64 (95% CI, 2.91-7.39), and large tongue = 3.08 (95% CI, 1.75-5.40). When grouped by the number of DAPs per case (0, 1, 2, 3, or ≥ 4), the odds of multiple DAPs in cases of FPH/SED compared with NPH/SED ranged from 2.89 (95% CI, 1.71-4.90) with 1 DAP to 24.55 (95% CI, 10.60-56.90) with ≥ 4 DAPs. Conclusion Cases of FPH/SED have more DAPs than NPH/SEDs.

Original languageEnglish (US)
Pages (from-to)343-347
Number of pages5
JournalAir Medical Journal
Volume34
Issue number6
DOIs
StatePublished - Nov 1 2015

Fingerprint

Intratracheal Intubation
Confidence Intervals
Hospital Emergency Service
Neck
Laryngoscopy
Trauma Centers
Blood Group Antigens
Tongue
Edema
Retrospective Studies
Odds Ratio
Air
Physicians

ASJC Scopus subject areas

  • Emergency
  • Emergency Medicine

Cite this

Association between Difficult Airway Predictors and Failed Prehosptial Endotracheal Intubation. / Gaither, Joshua B; Stolz, Uwe; Ennis, Joshua; Moiser, Jarrod; Sakles, John C.

In: Air Medical Journal, Vol. 34, No. 6, 01.11.2015, p. 343-347.

Research output: Contribution to journalArticle

Gaither, Joshua B ; Stolz, Uwe ; Ennis, Joshua ; Moiser, Jarrod ; Sakles, John C. / Association between Difficult Airway Predictors and Failed Prehosptial Endotracheal Intubation. In: Air Medical Journal. 2015 ; Vol. 34, No. 6. pp. 343-347.
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title = "Association between Difficult Airway Predictors and Failed Prehosptial Endotracheal Intubation",
abstract = "Objective Difficult airway predictors (DAPs) are associated with failure of endotracheal intubation (ETI) in the emergency department (ED). The purpose of this study was to determine if DAPs are associated with failure of prehospital ETI. Methods This retrospective study compared the prevalence of DAPs in cases of failed prehospital ETI successfully intubated in the ED (FPH/SED) with cases with no prehospital attempt that were successfully intubated in the ED on the first attempt by a physician using direct laryngoscopy (NPH/SED). All cases were transported by ground or air to an academic, level-1 trauma center. Results A total of 1377 ED ETIs were performed; 161 FPH/SED and 530 NPH/SED were identified. The odds ratios with 95{\%} confidence intervals (CIs) of finding DAPs in the FPH/SED group compared with the NPH/SED group was blood = 5.80 (95{\%} CI, 3.89-8.63), vomit = 2.01 (95{\%} CI, 1.25-3.21), short neck = 2.67 (95{\%} CI, 1.39-5.03), neck immobility = 2.52 (95{\%} CI, 1.72-3.67), airway edema = 10.52 (95{\%} CI, 4.15-29.92), facial trauma = 4.64 (95{\%} CI, 2.91-7.39), and large tongue = 3.08 (95{\%} CI, 1.75-5.40). When grouped by the number of DAPs per case (0, 1, 2, 3, or ≥ 4), the odds of multiple DAPs in cases of FPH/SED compared with NPH/SED ranged from 2.89 (95{\%} CI, 1.71-4.90) with 1 DAP to 24.55 (95{\%} CI, 10.60-56.90) with ≥ 4 DAPs. Conclusion Cases of FPH/SED have more DAPs than NPH/SEDs.",
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N2 - Objective Difficult airway predictors (DAPs) are associated with failure of endotracheal intubation (ETI) in the emergency department (ED). The purpose of this study was to determine if DAPs are associated with failure of prehospital ETI. Methods This retrospective study compared the prevalence of DAPs in cases of failed prehospital ETI successfully intubated in the ED (FPH/SED) with cases with no prehospital attempt that were successfully intubated in the ED on the first attempt by a physician using direct laryngoscopy (NPH/SED). All cases were transported by ground or air to an academic, level-1 trauma center. Results A total of 1377 ED ETIs were performed; 161 FPH/SED and 530 NPH/SED were identified. The odds ratios with 95% confidence intervals (CIs) of finding DAPs in the FPH/SED group compared with the NPH/SED group was blood = 5.80 (95% CI, 3.89-8.63), vomit = 2.01 (95% CI, 1.25-3.21), short neck = 2.67 (95% CI, 1.39-5.03), neck immobility = 2.52 (95% CI, 1.72-3.67), airway edema = 10.52 (95% CI, 4.15-29.92), facial trauma = 4.64 (95% CI, 2.91-7.39), and large tongue = 3.08 (95% CI, 1.75-5.40). When grouped by the number of DAPs per case (0, 1, 2, 3, or ≥ 4), the odds of multiple DAPs in cases of FPH/SED compared with NPH/SED ranged from 2.89 (95% CI, 1.71-4.90) with 1 DAP to 24.55 (95% CI, 10.60-56.90) with ≥ 4 DAPs. Conclusion Cases of FPH/SED have more DAPs than NPH/SEDs.

AB - Objective Difficult airway predictors (DAPs) are associated with failure of endotracheal intubation (ETI) in the emergency department (ED). The purpose of this study was to determine if DAPs are associated with failure of prehospital ETI. Methods This retrospective study compared the prevalence of DAPs in cases of failed prehospital ETI successfully intubated in the ED (FPH/SED) with cases with no prehospital attempt that were successfully intubated in the ED on the first attempt by a physician using direct laryngoscopy (NPH/SED). All cases were transported by ground or air to an academic, level-1 trauma center. Results A total of 1377 ED ETIs were performed; 161 FPH/SED and 530 NPH/SED were identified. The odds ratios with 95% confidence intervals (CIs) of finding DAPs in the FPH/SED group compared with the NPH/SED group was blood = 5.80 (95% CI, 3.89-8.63), vomit = 2.01 (95% CI, 1.25-3.21), short neck = 2.67 (95% CI, 1.39-5.03), neck immobility = 2.52 (95% CI, 1.72-3.67), airway edema = 10.52 (95% CI, 4.15-29.92), facial trauma = 4.64 (95% CI, 2.91-7.39), and large tongue = 3.08 (95% CI, 1.75-5.40). When grouped by the number of DAPs per case (0, 1, 2, 3, or ≥ 4), the odds of multiple DAPs in cases of FPH/SED compared with NPH/SED ranged from 2.89 (95% CI, 1.71-4.90) with 1 DAP to 24.55 (95% CI, 10.60-56.90) with ≥ 4 DAPs. Conclusion Cases of FPH/SED have more DAPs than NPH/SEDs.

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