Performing emergency Endotracheal Intubation is not the same as a pre-planned intubation procedure. The patients are already critically ill and time is limited. No leeway to properly prepare them as you would for a scheduled intervention. As such, the risk of associated complications is higher. But how much higher? How often do major clinical events occur in these settings?
That’s the question an international study published in 2021 sought to answer. The team analyzed records from 197 sites across 5 continents, covering a total of 2964 patients that went under emergency Endotracheal Intubation. They found out that 45% of the patients experienced a major adverse health event after that medical procedure. Cardiovascular instability was the most common event, affecting 42% of the studied patients, but others experienced even severe hypoxia or cardiac arrest.
But the damage seems to go deeper. For most of the patients (n=2942), the study was able to gather data on the mortality occurring over the 28 days following the intubation: 41% of patients who suffered a major adverse event died, versus 26% mortality of those who did not.
First-pass intubation correlated with reduced likelihood of major adverse events
In this study, clinicians successfully performed emergency intubation on the first try for 80% of the patients. The rate of major adverse events was significantly lower for cases requiring one attempt than for patients who needed two tries (43% vs 52%).
Video laryngoscopy increases chances of first-pass success
A video laryngoscope was used as the primary device only for 505 patients (17%), and mostly because clinicians marked the case as having at least one predicting factor of difficult airway. Despite not being used as the gold standard, this international study revealed that the videolaryngoscope was associated with a reduced chance of failing the “first-attempt” intubation.
Conclusion
Emergency intubations are very common, but remain a tricky procedure: in this study, nearly half the patients reported at least one major health adverse effect afterwards. Nailing the Endotracheal Intubation on the first attempt seems critical to reduce the chances of patients suffering such events. So, emergency intubation procedures should evolve towards maximizing the first-pass success. The widespread adoption of video laryngoscopy is a step in that direction. So is the incorporation of devices that, like the Airway Shield™, help simplify the intubation procedure for healthcare professionals and improve the likelihood of successful first-pass intubation.
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References
Russotto, V. et al. (2021). Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries. JAMA, 325(12): 1164-1172. doi:10.1001/jama.2021.1727