The importance of first pass success when performing orotracheal intubation in the emergency department

John C. Sakles, Stephen Chiu, Jarrod Mosier, Corrine Walker, Uwe Stolz

Research output: Contribution to journalArticle

185 Citations (Scopus)

Abstract

Objectives The goal of this study was to determine the association of first pass success with the incidence of adverse events (AEs) during emergency department (ED) intubations. Methods This was a retrospective analysis of prospectively collected continuous quality improvement data based on orotracheal intubations performed in an academic ED over a 4-year period. Following each intubation, the operator completed a data form regarding multiple aspects of the intubation, including patient and operator characteristics, method of intubation, device used, the number of attempts required, and AEs. Numerous AEs were tracked and included events such as witnessed aspiration, oxygen desaturation, esophageal intubation, hypotension, dysrhythmia, and cardiac arrest. Multivariable logistic regression was used to assess the relationship between the primary predictor variable of interest, first pass success, and the outcome variable, the presence of one or more AEs, after controlling for various other potential risk factors and confounders. Results Over the 4-year study period, there were 1,828 orotracheal intubations. If the intubation was successful on the first attempt, the incidence of one or more AEs was 14.2% (95% confidence interval [CI] = 12.4% to 16.2%). In cases requiring two attempts, the incidence of one or more AEs was 47.2% (95% CI = 41.8% to 52.7%); in cases requiring three attempts, the incidence of one or more AEs was 63.6% (95% CI = 53.7% to 72.6%); and in cases requiring four or more attempts, the incidence of one or more AEs was 70.6% (95% CI = 56.2.3% to 82.5%). Multivariable logistic regression showed that more than one attempt at tracheal intubation was a significant predictor of one or more AEs (adjusted odds ratio [aOR] = 7.52, 95% CI = 5.86 to 9.63). Conclusions When performing orotracheal intubation in the ED, first pass success is associated with a relatively small incidence of AEs. As the number of attempts increases, the incidence of AEs increases substantially.

Original languageEnglish (US)
Pages (from-to)71-78
Number of pages8
JournalAcademic Emergency Medicine
Volume20
Issue number1
DOIs
StatePublished - Jan 2013

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Intubation
Hospital Emergency Service
Incidence
Confidence Intervals
Logistic Models
Quality Improvement
Heart Arrest
Hypotension
Odds Ratio
Oxygen
Equipment and Supplies

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

The importance of first pass success when performing orotracheal intubation in the emergency department. / Sakles, John C.; Chiu, Stephen; Mosier, Jarrod; Walker, Corrine; Stolz, Uwe.

In: Academic Emergency Medicine, Vol. 20, No. 1, 01.2013, p. 71-78.

Research output: Contribution to journalArticle

Sakles, John C. ; Chiu, Stephen ; Mosier, Jarrod ; Walker, Corrine ; Stolz, Uwe. / The importance of first pass success when performing orotracheal intubation in the emergency department. In: Academic Emergency Medicine. 2013 ; Vol. 20, No. 1. pp. 71-78.
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abstract = "Objectives The goal of this study was to determine the association of first pass success with the incidence of adverse events (AEs) during emergency department (ED) intubations. Methods This was a retrospective analysis of prospectively collected continuous quality improvement data based on orotracheal intubations performed in an academic ED over a 4-year period. Following each intubation, the operator completed a data form regarding multiple aspects of the intubation, including patient and operator characteristics, method of intubation, device used, the number of attempts required, and AEs. Numerous AEs were tracked and included events such as witnessed aspiration, oxygen desaturation, esophageal intubation, hypotension, dysrhythmia, and cardiac arrest. Multivariable logistic regression was used to assess the relationship between the primary predictor variable of interest, first pass success, and the outcome variable, the presence of one or more AEs, after controlling for various other potential risk factors and confounders. Results Over the 4-year study period, there were 1,828 orotracheal intubations. If the intubation was successful on the first attempt, the incidence of one or more AEs was 14.2{\%} (95{\%} confidence interval [CI] = 12.4{\%} to 16.2{\%}). In cases requiring two attempts, the incidence of one or more AEs was 47.2{\%} (95{\%} CI = 41.8{\%} to 52.7{\%}); in cases requiring three attempts, the incidence of one or more AEs was 63.6{\%} (95{\%} CI = 53.7{\%} to 72.6{\%}); and in cases requiring four or more attempts, the incidence of one or more AEs was 70.6{\%} (95{\%} CI = 56.2.3{\%} to 82.5{\%}). Multivariable logistic regression showed that more than one attempt at tracheal intubation was a significant predictor of one or more AEs (adjusted odds ratio [aOR] = 7.52, 95{\%} CI = 5.86 to 9.63). Conclusions When performing orotracheal intubation in the ED, first pass success is associated with a relatively small incidence of AEs. As the number of attempts increases, the incidence of AEs increases substantially.",
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