Association Between Emergency Medical Service Agency Intubation Rate and Intubation Success - 19/06/24

Doi : 10.1016/j.annemergmed.2023.11.005

Jordan Thomas, MD ^a, Remle Crowe, PhD ^c, Kevin Schulz, MD ^a,^b,^d, Henry E. Wang, MD, MS ^e, Marcia C. De Oliveira Otto, PhD ^f, Bejamin Karfunkle, MD ^b, Eric Boerwinkle, PhD ^f, Ryan Huebinger, MD ^a,^b,^g,^⁎
^a Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX
^b Texas Emergency Medicine Research Center, McGovern Medical School, University of Texas Health Science Center, Houston, TX
^c ESO Solutions, Austin, TX
^d Houston Fire Department, Houston, TX
^e Department of Emergency Medicine, the Ohio State University, Columbus, OH
^f School of Public Health, UTHealth, Houston, TX
^g Department of Emergency Medicine (Huebinger), University of New Mexico, Albuquerque, NM

^∗Corresponding Author.

Abstract

Study Objective

Airway management is a crucial part of out-of-hospital care. It is not known if the rate of overall agency intubation attempts is associated with intubation success. We sought to evaluate the association between agency intubation attempt rate and intubation success using a national out-of-hospital database.

Methods

We conducted a retrospective secondary analysis of the ESO Data Collaborative from 2018 to 2019, and included all adult cases with an endotracheal intubation attempt. We calculated the number of intubations attempted per 100 responses, advanced life support responses, and transports for each agency. We excluded cases originating at health care facilities and outliers. We used multivariable logistic regression to evaluate the association between agency intubation attempt rate and 1) intubation success and 2) first-pass success. We adjusted for confounders.

Results

We included 1,005 agencies attempting 58,509 intubations. Overall, the intubation success rate was 78.8%, and the first-pass success rate was 68.5%. Per agency, the median rate of intubation attempts per 100 emergency medical service responses was 0.8 (interquartile range 0.6 to 1.1). Rates of intubation attempts per 100 responses (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI] 1.6 to 1.8), advanced life support responses (aOR 1.18; 95% CI 1.16 to 1.20), and transports (aOR 1.21; 95% CI 1.18 to 1.22) were all associated with intubation success. These relationships were similar for first-pass success but with smaller effect sizes.

Conclusion

Higher agency rates of intubation attempts were associated with increased rates of intubation success and first-pass success.

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Plan

Introduction

Materials and Methods

Study Design and Setting

Selection of Participants

Characteristics of Study Subjects

Main Results

Limitations

Discussion

	Please see page 2 for the Editor’s Capsule Summary of this article.
	Supervising editor: Robert A. De Lorenzo, MD, MSM. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: JT, RC, KS, HEW, EB, and RH conceived the study design. RH and JT conducted the data analysis. HEW, RC, MCD and BK provided statistical advice on the study design. JT drafted the manuscript. RH supervised the project. All authors contributed substantially to its revisions. RH takes responsibility for the article as a whole.
	Data sharing statement: The data dictionary is available upon request. Please email Ryan Huebinger at rhuebinger@salud.unm.edu.
	All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals' policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The authors report this article did not receive any outside funding or support.
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