K. N. Williams1, P. Rhee1, T. O’Keeffe1, B. Joseph1, M. Singer1, A. Tang1, G. Vercruysse1, N. Kulvatunyou1, J. Sakles1 1University Of Arizona,Division Of Trauma,Tucson, AZ, USA
Introduction: There is variability amongst trauma centers as to who primarily manages the airway of trauma patients, with some utilizing anesthesia personnel and others emergency department physicians. It is not known if this impacts the success rates for intubation in trauma patients. The aim of this study was to examine success rates and complications from a prospectively collected database. Our hypothesis was that ED physicians can effectively intubate trauma patients with few complications.
Methods: An analysis of a prospectively collected database of all adult (≥18 years old) trauma patients requiring intubation at a level I trauma center over a 6 year period (2009-2015) was performed. The database was a quality improvement database collected in the trauma bays and was matched to the institutional trauma registry for additional data. All initial intubation attempts were performed by an emergency physician. After intubation, the physician that performed the intubation completed a structured data collection form that included: demographics, complications, and the presence of difficult airway characteristics (DACs). Our primary outcome was first pass success of intubations. Secondary outcomes were number of attempts, success in patients with DACs and immediate complications.
Results: 972 patients met analysis criteria. The successful intubation rate by emergency medicine physicians was 98%. An Anesthesiologist was called for 7 patients (0.7%) and a surgical airway was required in only 12 (1.2%) patients. Five were for failed intubations, four for cardiac arrest and three for primary surgical airway. First attempt success rate was 80% and the second attempt success rate was 95%. The first emergency physician was successful in intubating the patient 93% of the time and only 7% needed rescue by a senior resident or attending. PGY1 residents (n=126) had a first attempt success rate of 69% and complication rate of 26.2%, compared to PGY3 residents (n=393) with an 82% (p=.019) first attempt success rate and an 18.8% (p=.082) complication rate. The overall complication rate was 21%. Complications included, desaturation (14%), esophageal intubation (2%), cardiac arrest (0.9%), aspiration (0.8%), hypotension (0.5%), dysrhythmia (0.5%), dental/airway trauma (0.3%) and laryngospasm (0.1%). When comparing the first three years of the study period to the latter three years, the first pass success rate was 74% during the first half of the study period, compared to 86% (p=.001) during the second half (when GlideScope Videolaryngoscopy (GVL) was increasingly utilized). There was no difference in overall complication rates between the first and second half of the study period (p=0.84).
Conclusion: The overall rate of successful intubation in trauma patients is high and the need for emergency rescue is very low; Emergency Department physicians can safely intubate trauma patients with high success rates comparable to those reported in the anesthesiology literature.