Risk factors for failed first intubation attempt in an out-of-hospital setting: a multicenter prospective study.

Autor: Galinski M; Pôle Urgences adultes - SAMU, Hôpital Pellegrin, CHU de Bordeaux, 33076, Bordeaux Cedex, France. michel.galinski@chu-bordeaux.fr.; INSERM U1219, Bordeaux Population Health Research Centre, IETO Team, Bordeaux University-ISPED, Bordeaux, France. michel.galinski@chu-bordeaux.fr., Wrobel M; Pôle Urgences - SAMU 64, Centre hospitalier de Pau, 64000, Pau, France., Boyer R; Pôle Urgences adultes - SAMU, Hôpital Pellegrin, CHU de Bordeaux, 33076, Bordeaux Cedex, France., Reuter PG; AP-HP, SAMU 92, Hôpital Raymond Poincaré, 92380, Garches, France.; Inserm, Équipe Soins Primaires Et Prévention, CESP, Université Paris-Saclay, UVSQ, Univ. Paris-Sud, 94807, Villejuif, France., Ruscev M; SMUR de Gonesse, Centre Hospitalier, 95503, Gonesse, France., Debaty G; SAMU 38 Hôpital La Tronche, CHU de Grenoble, 38000, Grenoble, France., Bagou G; SAMU 69 Hôpital Edouard Herriot, CHU de Lyon, 69000, Lyon, France., Dehours E; Pôle Urgences - SAMU 31, Hôpital Purpan, CHU de Toulouse, 31000, Toulouse, France., Bosc J; Pôle Urgences - SMUR, Hôpital Robert Boulin, 33243, Libourne, France., Lorendeau JP; Pôle Urgences - SAMU 24, Hôpital de Périgueux, 24000, Périgueux, France., Goddet S; Pôle Urgences - SAMU 21, CHU de Dijon, 21000, Dijon, France., Marouf K; Pôle Urgences - SAMU 49, CHU d'Angers, 49000, Angers, France., Catoire P; Pôle Urgences adultes - SAMU, Hôpital Pellegrin, CHU de Bordeaux, 33076, Bordeaux Cedex, France.; INSERM U1219, Bordeaux Population Health Research Centre, IETO Team, Bordeaux University-ISPED, Bordeaux, France., Combes X; Pôle Urgences adultes - SAMU, Hôpital Pellegrin, CHU de Bordeaux, 33076, Bordeaux Cedex, France.; INSERM U1219, Bordeaux Population Health Research Centre, IETO Team, Bordeaux University-ISPED, Bordeaux, France., Simonnet B; Pôle Urgences adultes - SAMU, Hôpital Pellegrin, CHU de Bordeaux, 33076, Bordeaux Cedex, France., Gil-Jardiné C; Pôle Urgences adultes - SAMU, Hôpital Pellegrin, CHU de Bordeaux, 33076, Bordeaux Cedex, France.; INSERM U1219, Bordeaux Population Health Research Centre, IETO Team, Bordeaux University-ISPED, Bordeaux, France.
Jazyk: angličtina
Zdroj: Internal and emergency medicine [Intern Emerg Med] 2023 Jan; Vol. 18 (1), pp. 265-272. Date of Electronic Publication: 2022 Oct 19.
DOI: 10.1007/s11739-022-03120-8
Abstrakt: This study was performed to identify variables potentially associated with failure of the first intubation attempt in an out-of-hospital emergency setting, considering all aspects of tracheal intubation. This observational prospective multicenter study was performed over 17 months and involved 10 prehospital emergency medical units. After each tracheal intubation, the operator was required to provide information concerning operator and patient characteristics, as well as the environmental conditions during intubation, by completing a data collection form. The primary endpoint was failure of the first intubation attempt. During the study period, 1546 patients were analyzed, of whom 59% were in cardiac arrest; 486 intubations failed on the first attempt (31.4% [95% confidence interval = 30.2-32.6]). Multivariate analysis revealed that the following 7 of 28 factors were associated with an increased risk of a failed first intubation attempt: operator with fewer than 50 prior intubations (odds ratio [OR] = 1.8 [1.4-2.4]), small inter-incisor space (OR = 2.3 [1.7-3.2]), limited extension of the head (OR = 1.6 [1.1-2.1]), macroglossia (OR = 2.3 [1.6-3.2]), ear/nose/throat (ENT) tumor (OR = 4.4 [1.4-13.4]), cardiac arrest (OR = 1.8 [1.3-2.6]), and vomiting (OR = 1.7 [1.3-2.3]). The frequency of adverse events among non-cardiac arrest patients was 17.6%; it increased with each additional intubation attempt. The first intubation attempt failed in more than 30% of cases, and seven variables were associated with increased risk of failure. Most of these factors could not be predicted.
(© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)
Databáze: MEDLINE
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