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

Autor: Goto Y; Department of Emergency and Critical Care Nagoya University Hospital Nagoya Aichi Japan., Goto T; Graduate School of Medical Sciences University of Fukui Fukui Japan., Okamoto H; Centre for Clinical Epidemiology Department of Emergency Medicine St. Luke's International Hospital Tokyo Japan., Hagiwara Y; Department of Pediatric Emergency and Critical Care Medicine Tokyo Metropolitan Children's Medical Centre Tokyo Japan., Watase H; Department of Surgery University of Washington Seattle Washington., Hasegawa K; Department of Emergency Medicine Harvard Medical School Massachusetts General Hospital Boston Massachusetts.
Jazyk: angličtina
Zdroj: Acute medicine & surgery [Acute Med Surg] 2019 Oct 14; Vol. 7 (1), pp. e462. Date of Electronic Publication: 2019 Oct 14 (Print Publication: 2020).
DOI: 10.1002/ams2.462
Abstrakt: 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.
Competing Interests: Ethics approval and consent to participate: The institutional review board at each participating institution approved the study with a waiver of informed consent. Consent for publication: N/A. Availability of data and materials: The study data cannot be made publicly available because it contains protected health information of the participants and violates the ethical agreement with the institutional review boards that approved the study. Animal studies: N/A. Conflict of interest: None declared.
(© 2019 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)
Databáze: MEDLINE
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