Abstract and Introduction
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.
Introduction
The advent of emergency medicine as a specialty has led to advances in emergency airway management. Residency training in emergency medicine emphasizes airway management, including use of rapid sequence intubation (RSI), defined as intubation after rapid induction and paralysis. Several previous studies, mostly with small samples, have reported intubation success rates within single institutions, but comprehensive large multi-center studies are lacking.
Although intubation frequently is performed in emergency departments (EDs) today, little is known about why and how ED patients are intubated, and by whom. Surveillance of critical emergency procedures is essential for reasons of public health, policy, and clinical practice development. Our goal in this report is to describe emergency intubation indications, methods used, operator characteristics, and adverse event rates using a multi-center registry model.