Factors associated with successful rescue intubation attempts in the emergency department: an analysis of multicenter prospective observational study in Japan

Yukari Goto; Tadahiro Goto; Hiroshi Okamoto; Yusuke Hagiwara; Hiroko Watase; Kohei Hasegawa; Japanese Emergency Medicine Network Investigators

doi:10.1002/ams2.462

Factors associated with successful rescue intubation attempts in the emergency department: an analysis of multicenter prospective observational study in Japan

Acute Med Surg. 2019 Oct 14;7(1):e462. doi: 10.1002/ams2.462. eCollection 2020 Jan-Dec.

Authors

Yukari Goto¹, Tadahiro Goto², Hiroshi Okamoto³, Yusuke Hagiwara⁴, Hiroko Watase⁵, Kohei Hasegawa⁶; Japanese Emergency Medicine Network Investigators

Collaborators

Japanese Emergency Medicine Network Investigators:
Hiroshi Morita, Takahisa Kawano, Yohei Kamikawa, Hideya Nagai, Takashi Matsumoto, Suguru Nonami, Yusuke Miyoshi, Sho Segawa, Yuya Kitai, Kenzo Tanaka, Saburo Minami, Hiromasa Yakushiji, Naoto Miyauchi, Yudai Yano, Nobuhiro Sato, Koichiro Gibo, Masashi Okubo, Shojiro Oka, Yukiko Nakayama, Nobuhiro Miyamae, Kaoru Hirose, Taichi Imamura, Azusa Uendan, Yasuaki Koyama, Hiroshi Kamura, Yoshiyuki Nakashima, Jin Takahashi, Jin Irie, Nobunaga Okada, Seiro Oya, Akihiko Inoue

Affiliations

¹ Department of Emergency and Critical Care Nagoya University Hospital Nagoya Aichi Japan.
² Graduate School of Medical Sciences University of Fukui Fukui Japan.
³ Centre for Clinical Epidemiology Department of Emergency Medicine St. Luke's International Hospital Tokyo Japan.
⁴ Department of Pediatric Emergency and Critical Care Medicine Tokyo Metropolitan Children's Medical Centre Tokyo Japan.
⁵ Department of Surgery University of Washington Seattle Washington.
⁶ Department of Emergency Medicine Harvard Medical School Massachusetts General Hospital Boston Massachusetts.

Abstract

Aim: It remains unclear whether physicians should change intubation approaches after the failed first attempt. We aimed to determine the rescue intervention approaches associated with a higher success rate at the second attempt in the emergency department (ED).

Methods: We analyzed the data from a prospective, multicenter, observational study - the second Japanese Emergency Airway Network Study. The current analysis included all patients who underwent emergency intubation from February 2012 through November 2017. We defined a rescue intubation attempt as a second intubation attempt with any change in intubation approaches (i.e., change in methods, devices, or intubators) from the failed first attempt. The outcome measure was second-attempt success.

Results: Of 2,710 patients with a failed first attempt, 43% underwent a second intubation attempt with changes in intubation approach (i.e., rescue intubation). Rescue intubation attempts were associated with a higher second-attempt success rate compared to non-rescue intubation attempts (adjusted odds ratio [OR], 1.78; 95% confidence interval [CI], 1.50-2.12). The rescue intubation approaches associated with a higher second-attempt success were changes from non-rapid sequence intubation (RSI) to RSI (adjusted OR, 2.04; 95% CI, 1.12-3.75), from non-emergency medicine (EM) residents to EM residents (adjusted OR, 2.02; 95% CI, 1.44-2.82), and from non-EM attending physicians to EM attending physicians (adjusted OR, 2.82; 95% CI, 2.14-3.71).

Conclusions: In this large multicenter study, rescue interventions were associated with a higher second-attempt success rate. The data also support the use of RSI and backup by EM residents or EM attending physicians to improve the airway management performance after a failed attempt in the ED.

Keywords: Emergency department; rescue intubation attempt; second intubation attempt; success rate.