Intubation Practices in Community Emergency Departments - 10/01/25

Doi : 10.1016/j.annemergmed.2024.11.021

Jonathan Kei, MD, MPH ^⁎ , Travis Eurick, MD, Tom A. Hauck, BS
Department of Emergency Medicine, Kaiser Permanente San Diego Medical Center, San Diego, CA

^∗Corresponding Author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 10 January 2025

Abstract

Study objective

This study analyzes emergency medicine airway management trends and outcomes among community emergency departments.

Methods

A multicenter, retrospective chart review was conducted on 11,475 intubations from 15 different community emergency departments between January 1, 2015, and December 31, 2022. Data collected included patient’s age, sex, rapid sequence intubation medications, use of cricoid pressure, method of intubation, number of attempts, admission diagnosis, and all-cause mortality rates.

Results

Active cardiopulmonary resuscitation occurred in 11.4% of intubations. When rapid sequence intubation was employed, the most frequently used induction agents were etomidate (91.6%), propofol (4.3%), and ketamine (4.1%). From 2015 to 2022, the use of rocuronium (versus succinylcholine) increased from 33.9% to 61.9%, a difference of 28% (95% confidence interval [CI] 21.1% to 34.9%). During the same period, video laryngoscopy (versus direct laryngoscopy) increased from 27.4% to 77.7%, a difference of 50.3% (95% CI 44.2% to 56.4%). Only 46% of intubations used cricoid pressure. Physicians had a first-pass success rate of 80.5% and a failure rate of 0.2%. The most common documented admission diagnoses among intubated patients were respiratory etiologies (27.8%), neurologic causes (21.4%), and sepsis (16.0%). All-cause mortality rates were high for intubated patients at 24 hours (19.7%), 7 days (29.4%), 30 days (38.4%), and 1 year (45.4%).

Conclusion

Physicians intubating in community emergency departments have similar rates of first-pass success and failure seen in academic Level-1 trauma centers despite treating medically sick patients with high all-cause mortality rates. Dramatic shifts in choice of paralytic and method for intubation were seen.

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Keywords : Airway, Rapid Sequence Intubation, Endotracheal Intubation

Plan

Introduction

Background

Importance

Goals of This Investigation

Materials and Methods

Study Design and Study Participants

Data Collection

Data Management and Analysis

Results

Characteristics of Study Subjects

Main Results

Limitations

Discussion

	Please see page XX for the Editor’s Capsule Summary of this article.
	Supervising editor: Gregory W. Hendey, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: JK conceived and designed the study. JK and TE applied and were granted approval by the IRB. JK and TAH supervised the trial and data collection. JK, TE, and TAH provided statistical advice on study design and analyzed the data. JK drafted the manuscript, and all authors contributed to its revision. JK takes responsibility for the paper as a whole.
	Data sharing statement: The entire deidentified data set, data dictionary, and analytics for this investigation are available on request from the date of article publication by contacting Jonathan Kei, MD, at email: jonathankei@kaiser-ed.com. Investigators requesting data set information must provide an IRB letter of approval for its release.
	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.
	Presentation information: The abstract for this study was presented at the ACEP Scientific Assembly, Research Forum in Philadelphia, Pennsylvania, on October 9, 2023.