A Prospective Observational Study of Emergency Airway Management in Emergency Department
Winchana Srivilaithon MD*
Affiliation : * Department of Emergency Medicine, Thammasat University, Pathumthani, Thailand
Background and
Objective : In the emergency department (ED), airway management by emergency physicians is becoming
more common. The presented study described emergency intubation indications, methods, operator characteristics, success
rates, and adverse event rates.
Material and Method: Prospective observational study using data collection form was done in the ED of Thammasat
University Hospital from September 2012 to August 2015. Data were collected by each physician intubator at the time of each
intubation.
Results : The author recorded 1,393 encounters underwent intubation in ED. Intubation was ultimately successful in 99.43%.
Cardiac arrest (18.95%) and head injury (7.32%) were the most common indication for intubation in medical encounters and
trauma encounters, respectively. The overall success rates on the first attempt were 74.66% (95% confidence interval (CI);
72.37-76.94%). Rapid sequence intubation (RSI) was used in 22.47% of all encounters, had success rates on the first attempt
of intubation higher than sedation without paralysis (79.55% vs. 66.09%, risk difference 15.93%, 95% CI for difference
[8.64-23.23%]; p<0.01). Senior physicians in emergency medicine had the highest rates of successful intubation on the first
attempt (81.94%, 95% CI; 78.84-85.03%). The overall adverse event rates were 8.47%.
Conclusion : The presented study observed high overall intubation success rates in ED. RSI has the highest success rates in
the first attempt of intubation. Resident and staff in emergency medicine take major role in airway management. Training in
emergency medicine residency programs can improve airway management skill.
Keywords : Emergency airway management, Intubation, Emergency department, Rapid sequence intubation, Success rate
