Emergency airway management

A multi-center report of 8937 Emergency Department intubations

Ron M. Walls, Calvin A. Brown, Aaron E Bair, Daniel J. Pallin

Research output: Contribution to journalArticle

120 Citations (Scopus)

Abstract

Objective: Emergency department (ED) intubation personnel and practices have changed dramatically in recent decades, but have been described only in single-center studies. We sought to better describe ED intubations by using a multi-center registry. Methods: We established a multi-center registry and initiated surveillance of a longitudinal, prospective convenience sample of intubations at 31 EDs. Clinicians filled out a data form after each intubation. Our main outcome measures were descriptive. We characterized indications, methods, medications, success rates, intubator characteristics, and associated event rates. We report proportions with 95% confidence intervals and chi-squared testing; p-values < 0.05 were considered significant. Results: There were 8937 encounters recorded from September 1997 to June 2002. The intubation was performed for medical emergencies in 5951 encounters (67%) and for trauma in 2337 (26%); 649 (7%) did not have a recorded mechanism or indication. Rapid sequence intubation was the initial method chosen in 6138 of 8937 intubations (69%) and in 84% of encounters that involved any intubation medication. The first method chosen was successful in 95%, and intubation was ultimately successful in 99%. Emergency physicians performed 87% of intubations and anesthesiologists 3%. Several other specialties comprised the remaining 10%. One or more associated events were reported in 779 (9%) encounters, with an average of 12 per 100 encounters. No medication errors were reported in 6138 rapid sequence intubations. Surgical airways were performed in 0.84% of all cases and 1.7% of trauma cases. Conclusion: Emergency physicians perform the vast majority of ED intubations. ED intubation is performed more commonly for medical than traumatic indications. Rapid sequence intubation is the most common method of ED intubation.

Original languageEnglish (US)
Pages (from-to)347-354
Number of pages8
JournalJournal of Emergency Medicine
Volume41
Issue number4
DOIs
StatePublished - Oct 2011

Fingerprint

Airway Management
Intubation
Hospital Emergency Service
Emergencies
Registries
Physicians
Medication Errors
Wounds and Injuries

Keywords

  • airway
  • airway management
  • emergency airway
  • Emergency Department
  • emergency physician
  • rapid sequence intubation
  • registry

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Emergency airway management : A multi-center report of 8937 Emergency Department intubations. / Walls, Ron M.; Brown, Calvin A.; Bair, Aaron E; Pallin, Daniel J.

In: Journal of Emergency Medicine, Vol. 41, No. 4, 10.2011, p. 347-354.

Research output: Contribution to journalArticle

Walls, Ron M. ; Brown, Calvin A. ; Bair, Aaron E ; Pallin, Daniel J. / Emergency airway management : A multi-center report of 8937 Emergency Department intubations. In: Journal of Emergency Medicine. 2011 ; Vol. 41, No. 4. pp. 347-354.
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abstract = "Objective: Emergency department (ED) intubation personnel and practices have changed dramatically in recent decades, but have been described only in single-center studies. We sought to better describe ED intubations by using a multi-center registry. Methods: We established a multi-center registry and initiated surveillance of a longitudinal, prospective convenience sample of intubations at 31 EDs. Clinicians filled out a data form after each intubation. Our main outcome measures were descriptive. We characterized indications, methods, medications, success rates, intubator characteristics, and associated event rates. We report proportions with 95{\%} confidence intervals and chi-squared testing; p-values < 0.05 were considered significant. Results: There were 8937 encounters recorded from September 1997 to June 2002. The intubation was performed for medical emergencies in 5951 encounters (67{\%}) and for trauma in 2337 (26{\%}); 649 (7{\%}) did not have a recorded mechanism or indication. Rapid sequence intubation was the initial method chosen in 6138 of 8937 intubations (69{\%}) and in 84{\%} of encounters that involved any intubation medication. The first method chosen was successful in 95{\%}, and intubation was ultimately successful in 99{\%}. Emergency physicians performed 87{\%} of intubations and anesthesiologists 3{\%}. Several other specialties comprised the remaining 10{\%}. One or more associated events were reported in 779 (9{\%}) encounters, with an average of 12 per 100 encounters. No medication errors were reported in 6138 rapid sequence intubations. Surgical airways were performed in 0.84{\%} of all cases and 1.7{\%} of trauma cases. Conclusion: Emergency physicians perform the vast majority of ED intubations. ED intubation is performed more commonly for medical than traumatic indications. Rapid sequence intubation is the most common method of ED intubation.",
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