Airway management in the emergency department: A one-year study of 610 tracheal intubations

J. C. Sakles, Erik G Laurin, A. A. Rantapaa, Edward A Panacek

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315 Citations (Scopus)

Abstract

Study objective: To describe the methods, success rates, and immediate complications of tracheal intubations performed in the emergency department of an urban teaching hospital. Methods: This was an observational, consecutive series undertaken in an urban university hospital with an emergency medicine residency training program and an annual ED census of 60,000 patients. The study population included all patients for whom intubation was attempted in the ED during a 1-year period (July 1, 1995 through June 30, 1996). At the time of each intubation, the intubator filled out an intubation data collection form. If an intubation was performed in the ED but no form was filled out, the data were obtained from the medical record. Results: A total of 610 patients required airway control in the ED; 569 (93%) were intubated by emergency medicine residents or attending physicians. Rapid-sequence intubation (RSI) was used in 515 (84%). A total of 603 patients (98.9%) were successfully intubated; 7 patients could not be intubated and underwent cricothyrotomy. In 33 patients, inadvertent placement into the esophagus occurred; all such situations were rapidly recognized and corrected. Eight (24%) of the 33 esophageal intubations resulted in a reported immediate complication. Overall, 49 patients (8.0%; 95% confidence interval [CI], 6% to 11%) experienced a total of 57 immediate complications (9.3%; 95% CI, 7% to 12%). Three patients sustained a cardiac arrest after intubation; two of these patients had agonal rhythms before intubation, and one probably had a succinylcholine-induced hyperkalemic cardiac arrest. Conclusion: At this institution, the majority of ED intubations were performed by emergency physicians and RSI was the most common method used. Emergency physicians intubated critically ill and injured ED patients with a very high success rate and a low rate of serious complications.

Original languageEnglish (US)
Pages (from-to)325-332
Number of pages8
JournalAnnals of Emergency Medicine
Volume31
Issue number3
DOIs
StatePublished - 1998

Fingerprint

Airway Management
Intubation
Hospital Emergency Service
Emergency Medicine
Urban Hospitals
Physicians
Emergencies
Confidence Intervals
Induced Heart Arrest
Succinylcholine
Censuses
Internship and Residency
Heart Arrest
Critical Illness
Teaching Hospitals
Esophagus
Medical Records

ASJC Scopus subject areas

  • Emergency Medicine

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Airway management in the emergency department : A one-year study of 610 tracheal intubations. / Sakles, J. C.; Laurin, Erik G; Rantapaa, A. A.; Panacek, Edward A.

In: Annals of Emergency Medicine, Vol. 31, No. 3, 1998, p. 325-332.

Research output: Contribution to journalArticle

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abstract = "Study objective: To describe the methods, success rates, and immediate complications of tracheal intubations performed in the emergency department of an urban teaching hospital. Methods: This was an observational, consecutive series undertaken in an urban university hospital with an emergency medicine residency training program and an annual ED census of 60,000 patients. The study population included all patients for whom intubation was attempted in the ED during a 1-year period (July 1, 1995 through June 30, 1996). At the time of each intubation, the intubator filled out an intubation data collection form. If an intubation was performed in the ED but no form was filled out, the data were obtained from the medical record. Results: A total of 610 patients required airway control in the ED; 569 (93{\%}) were intubated by emergency medicine residents or attending physicians. Rapid-sequence intubation (RSI) was used in 515 (84{\%}). A total of 603 patients (98.9{\%}) were successfully intubated; 7 patients could not be intubated and underwent cricothyrotomy. In 33 patients, inadvertent placement into the esophagus occurred; all such situations were rapidly recognized and corrected. Eight (24{\%}) of the 33 esophageal intubations resulted in a reported immediate complication. Overall, 49 patients (8.0{\%}; 95{\%} confidence interval [CI], 6{\%} to 11{\%}) experienced a total of 57 immediate complications (9.3{\%}; 95{\%} CI, 7{\%} to 12{\%}). Three patients sustained a cardiac arrest after intubation; two of these patients had agonal rhythms before intubation, and one probably had a succinylcholine-induced hyperkalemic cardiac arrest. Conclusion: At this institution, the majority of ED intubations were performed by emergency physicians and RSI was the most common method used. Emergency physicians intubated critically ill and injured ED patients with a very high success rate and a low rate of serious complications.",
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