Association of airway obstruction with first-pass success and intubation-related adverse events in the emergency department: multicenter prospective observational studies

Jin Takahashi; Tadahiro Goto; Shigeki Fujitani; Hiroshi Okamoto; Yusuke Hagiwara; Hiroko Watase; Kohei Hasegawa; Japanese Emergency Medicine Network Investigators

doi:10.3389/fmed.2023.1199750

Association of airway obstruction with first-pass success and intubation-related adverse events in the emergency department: multicenter prospective observational studies

Front Med (Lausanne). 2023 May 25:10:1199750. doi: 10.3389/fmed.2023.1199750. eCollection 2023.

Authors

Jin Takahashi^{1

2}, Tadahiro Goto³, Shigeki Fujitani², Hiroshi Okamoto⁴, Yusuke Hagiwara⁵, Hiroko Watase⁶, Kohei Hasegawa⁷; Japanese Emergency Medicine Network Investigators

Affiliations

¹ Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.
² Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
³ TXP Medical Co., Ltd., Bunkyo, Tokyo, Japan.
⁴ Department of Critical Care Medicine, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.
⁵ Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
⁶ Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
⁷ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States.

Abstract

Background: Airway obstruction is a relatively rare but critical condition that requires urgent intervention in the emergency department (ED). The present study aimed to investigate the association of airway obstruction with first-pass success and intubation-related adverse events in the ED.

Methods: We analyzed data from two prospective multicenter observational studies of ED airway management. We included adults (aged ≥18 years) who underwent tracheal intubation for non-trauma indications from 2012 through 2021 (113-month period). Outcome measures were first-pass success and intubation-related adverse events. We constructed a multivariable logistic regression model adjusting for age, sex, modified LEMON score (without airway obstruction), intubation methods, intubation devices, bougie use, intubator's specialty, and ED visit year with accounting for patients clustering within the ED.

Results: Of 7,349 eligible patients, 272 (4%) underwent tracheal intubation for airway obstruction. Overall, 74% of patients had first-pass success and 16% had intubation-related adverse events. The airway obstruction group had a lower first-pass success rate (63% vs. 74%; unadjusted odds ratio [OR], 0.63; 95% CI, 0.49-0.80), compared to the non-airway obstruction group. This association remained significant in the multivariable analysis (adjusted OR 0.60, 95%CI 0.46-0.80). The airway obstruction group also had a significantly higher risk of adverse events (28% vs. 16%; unadjusted OR, 1.93; 95% CI, 1.48-2.56, adjusted OR, 1.70; 95% CI, 1.27-2.29). In the sensitivity analysis using multiple imputation, the results remained consistent with the main results: the airway obstruction group had a significantly lower first-pass success rate (adjusted OR, 0.60; 95% CI, 0.48-0.76).

Conclusion: Based on these multicenter prospective data, airway obstruction was associated with a significantly lower first-pass success rate and a higher intubation-related adverse event rate in the ED.

Keywords: adults; airway obstruction; emergency department; first-pass success; intubation-related adverse events.