Association Between Repeated Intubation Attempts and Adverse Events in Emergency Departments: An Analysis of a Multicenter Prospective Observational Study - 24/11/12
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Japanese Emergency Medicine Research Alliance Investigators
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Résumé |
Study objective |
Although repeated intubation attempts are believed to contribute to patient morbidity, only limited data characterize the association between the number of emergency department (ED) laryngoscopic attempts and adverse events. We seek to determine whether multiple ED intubation attempts are associated with an increased risk of adverse events.
Methods |
We conducted an analysis of a multicenter prospective registry of 11 Japanese EDs between April 2010 and September 2011. All patients undergoing emergency intubation with direct laryngoscopy as the initial device were included. The primary exposure was multiple intubation attempts, defined as intubation efforts requiring greater than or equal to 3 laryngoscopies. The primary outcome measure was the occurrence of intubation-related adverse events in the ED, including cardiac arrest, dysrhythmia, hypotension, hypoxemia, unrecognized esophageal intubation, regurgitation, airway trauma, dental or lip trauma, and mainstem bronchus intubation.
Results |
Of 2,616 patients, 280 (11%) required greater than or equal to 3 intubation attempts. Compared with patients requiring 2 or fewer intubation attempts, patients undergoing multiple attempts exhibited a higher adverse event rate (35% versus 9%). After adjusting for age, sex, principal indication, method, medication, and operator characteristics, intubations requiring multiple attempts were associated with an increased odds of adverse events (odds ratio 4.5; 95% confidence interval 3.4 to 6.1).
Conclusion |
In this large Japanese multicenter study of ED patients undergoing intubation, we found that multiple intubation attempts were independently associated with increased adverse events.
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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. This study was supported by a grant from St. Luke's Life Science Institute and a grant from Massachusetts General Hospital and Brigham and Women's Hospital. The study sponsors had no involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the article; or in the decision to submit the article for publication. |
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Please see page 750 for the Editor's Capsule Summary of this article. |
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Supervising editor: Henry E. Wang, MD, MS |
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Author contributions: KH, KS, and DFMB conceived the study. KH obtained research funding. KH, YH, TC, HW, and CAB supervised the conduct of the trial and data collection. YH, TC, and HW managed the data, including quality control. YH and HW provided statistical advice on study design and analyzed the data. KH chaired the data oversight committee. KH drafted the article, and all authors contributed substantially to its revision. KH takes responsibility for the paper as a whole. |
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Publication date: Available online April 28, 2012. |
Vol 60 - N° 6
P. 749 - décembre 2012 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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