A prospective study of tracheal intubation in an emergency department in Hong Kong

Abstract

Emergency department (ED) doctors often intubate patients, however no data was available in Hong Kong on this aspect. Our study was to assess the competency of ED doctors in intubating critical patients in a typical ED in Hong Kong. Between March and August 1999, in an urban hospital with an emergency physician training programme, all doctors, after performing any tracheal intubation, were required to fill in a pro forma designed for the study. Data collected included the training status of the intubator, the number of intubation attempts, intubation methods and complications. A total of 214 ED patients required advanced airway management including 87 (41%) patients in cardiopulmonary arrest; 207 (97%) of them were successfully intubated by ED doctors (76 by specialists, 61 by trainees, 70 by residents) and 90% were successful in the first attempt. The remaining seven patients’ airway control was eventually managed by anaesthetists who successfully intubated six patients and performed cricothyrotomy for one patient. Rapid sequence intubation was performed in 70 (33%) patients by ED doctors and specialists. There were 30 (14%) patients successfully intubated using sedative agents alone. Twenty-two (10%) patients were found to have a total of 32 complications including 13 patients with oesophageal intubation, seven with soft tissue damage, four with desaturation, three with bronchial intubation, three with hypotension, one with dental trauma, one with dysrhythmia. The majority of ED intubations for critically ill patients were performed by ED doctors with high success rate and few major complications.