Prospective observational study of the practice of endotracheal intubation in the emergency department of a tertiary hospital in Sydney, Australia

Abstract

Objective To describe the practice of endotracheal intubation in the ED of a tertiary hospital in Australia, with particular emphasis on the indication, staff seniority, technique, number of attempts required and the rate of complications. Methods A prospective observational study. Results Two hundred and ninety-five intubations occurred in 18 months. Trauma was the indication for intubation in 30.5% (95% CI 25.3–36.0) and medical conditions in 69.5% (95% CI 64.0–74.5). Emergency physicians were team leaders in 69.5% (95% CI 64.0–74.5), whereas ED registrars or senior Resident Medical Officers made the first attempt at intubation in 88.1% (95% CI 83.9–91.3). Difficult laryngoscopy occurred in 24.0% (95% CI 19.5–29.3) of first attempts, whereas first pass success occurred in 83.4% (95% CI 78.7–87.2). A difficult intubation occurred in 3.4% (95% CI 1.9–6.1) and all patients were intubated orally in five or less attempts. A bougie was used in 30.9% (95% CI 25.8–36.5) of first attempts, whereas a stylet in 37.5% (95% CI 32.1–43.3). Complications occurred in 29.0% (95% CI 23.5–34.1) of the patients, with desaturation the commonest in 15.7% (95% CI 11.9–20.5). Cardiac arrest occurred in 2.2% (95% CI 0.9–4.4) after intubation. No surgical airways were undertaken. Conclusion Although the majority of results are comparable with overseas data, the rates of difficult laryngoscopy and desaturation are higher than previously reported. We feel that this data has highlighted the need for practice improvement within our department and we would encourage all those who undertake emergent airway management to audit their own practice of this high-risk procedure.