PMID- 23574475
OWN - NLM
STAT- MEDLINE
DCOM- 20131106
LR  - 20220409
IS  - 1553-2712 (Electronic)
IS  - 1069-6563 (Print)
IS  - 1069-6563 (Linking)
VI  - 20
IP  - 1
DP  - 2013 Jan
TI  - The importance of first pass success when performing orotracheal intubation in 
      the emergency department.
PG  - 71-8
LID - 10.1111/acem.12055 [doi]
AB  - OBJECTIVES: The goal of this study was to determine the association of first pass 
      success with the incidence of adverse events (AEs) during emergency department 
      (ED) intubations. METHODS: This was a retrospective analysis of prospectively 
      collected continuous quality improvement data based on orotracheal intubations 
      performed in an academic ED over a 4-year period. Following each intubation, the 
      operator completed a data form regarding multiple aspects of the intubation, 
      including patient and operator characteristics, method of intubation, device 
      used, the number of attempts required, and AEs. Numerous AEs were tracked and 
      included events such as witnessed aspiration, oxygen desaturation, esophageal 
      intubation, hypotension, dysrhythmia, and cardiac arrest. Multivariable logistic 
      regression was used to assess the relationship between the primary predictor 
      variable of interest, first pass success, and the outcome variable, the presence 
      of one or more AEs, after controlling for various other potential risk factors 
      and confounders. RESULTS: Over the 4-year study period, there were 1,828 
      orotracheal intubations. If the intubation was successful on the first attempt, 
      the incidence of one or more AEs was 14.2% (95% confidence interval [CI] = 12.4% 
      to 16.2%). In cases requiring two attempts, the incidence of one or more AEs was 
      47.2% (95% CI = 41.8% to 52.7%); in cases requiring three attempts, the incidence 
      of one or more AEs was 63.6% (95% CI = 53.7% to 72.6%); and in cases requiring 
      four or more attempts, the incidence of one or more AEs was 70.6% (95% CI = 
      56.2.3% to 82.5%). Multivariable logistic regression showed that more than one 
      attempt at tracheal intubation was a significant predictor of one or more AEs 
      (adjusted odds ratio [aOR] = 7.52, 95% CI = 5.86 to 9.63). CONCLUSIONS: When 
      performing orotracheal intubation in the ED, first pass success is associated 
      with a relatively small incidence of AEs. As the number of attempts increases, 
      the incidence of AEs increases substantially.
CI  - (c) 2013 by the Society for Academic Emergency Medicine.
FAU - Sakles, John C
AU  - Sakles JC
AD  - Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA. 
      sakles@aemrc.arizona.edu
FAU - Chiu, Stephen
AU  - Chiu S
FAU - Mosier, Jarrod
AU  - Mosier J
FAU - Walker, Corrine
AU  - Walker C
FAU - Stolz, Uwe
AU  - Stolz U
LA  - eng
GR  - T35 HL007479/HL/NHLBI NIH HHS/United States
PT  - Evaluation Study
PT  - Journal Article
PL  - United States
TA  - Acad Emerg Med
JT  - Academic emergency medicine : official journal of the Society for Academic 
      Emergency Medicine
JID - 9418450
SB  - IM
CIN - Acad Emerg Med. 2013 Sep;20(9):966. PMID: 23981050
CIN - Acad Emerg Med. 2013 Sep;20(9):965. PMID: 23981076
MH  - Adult
MH  - Aged
MH  - *Clinical Competence
MH  - Cohort Studies
MH  - Confidence Intervals
MH  - Emergency Medicine/standards/trends
MH  - *Emergency Service, Hospital
MH  - Female
MH  - Humans
MH  - Intubation, Intratracheal/*adverse effects/instrumentation/*methods
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Quality Improvement
MH  - Retreatment
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Time Factors
PMC - PMC4530518
MID - NIHMS705574
EDAT- 2013/04/12 06:00
MHDA- 2013/11/07 06:00
PMCR- 2015/08/10
CRDT- 2013/04/12 06:00
PHST- 2012/05/16 00:00 [received]
PHST- 2012/07/25 00:00 [revised]
PHST- 2012/07/30 00:00 [accepted]
PHST- 2013/04/12 06:00 [entrez]
PHST- 2013/04/12 06:00 [pubmed]
PHST- 2013/11/07 06:00 [medline]
PHST- 2015/08/10 00:00 [pmc-release]
AID - 10.1111/acem.12055 [doi]
PST - ppublish
SO  - Acad Emerg Med. 2013 Jan;20(1):71-8. doi: 10.1111/acem.12055.