Incidence of rescue surgical airways after attempted orotracheal intubation in the emergency department: A National Emergency Airway Registry (NEAR) Study.

Autor: Offenbacher J; Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America. Electronic address: joseph.offenbacher@nyulangone.org., Nikolla DA; Department of Emergency Medicine, Saint Vincent Hospital, Allegheny Health Network, Erie, PA, United States of America., Carlson JN; Department of Emergency Medicine, Saint Vincent Hospital, Allegheny Health Network, Erie, PA, United States of America., Smith SW; Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America; Institute for Innovations in Medical Education, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America., Genes N; Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America., Boatright DH; Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America., Brown CA 3rd; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States of America.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2023 Jun; Vol. 68, pp. 22-27. Date of Electronic Publication: 2023 Feb 25.
DOI: 10.1016/j.ajem.2023.02.020
Abstrakt: Background: Cricothyrotomy is a critical technique for rescue of the failed airway in the emergency department (ED). Since the adoption of video laryngoscopy, the incidence of rescue surgical airways (those performed after at least one unsuccessful orotracheal or nasotracheal intubation attempt), and the circumstances where they are attempted, has not been characterized.
Objective: We report the incidence and indications for rescue surgical airways using a multicenter observational registry.
Methods: We performed a retrospective analysis of rescue surgical airways in subjects ≥14 years of age. We describe patient, clinician, airway management, and outcome variables.
Results: Of 19,071 subjects in NEAR, 17,720 (92.9%) were ≥14 years old with at least one initial orotracheal or nasotracheal intubation attempt, 49 received a rescue surgical airway attempt, an incidence of 2.8 cases per 1000 (0.28% [95% confidence interval 0.21 to 0.37]). The median number of airway attempts prior to rescue surgical airways was 2 (interquartile range 1, 2). Twenty-five were in trauma victims (51.0% [36.5 to 65.4]), with neck trauma being the most common traumatic indication (n = 7, 14.3% [6.4 to 27.9]).
Conclusion: Rescue surgical airways occurred infrequently in the ED (0.28% [0.21 to 0.37]), with approximately half performed due to a trauma indication. These results may have implications for surgical airway skill acquisition, maintenance, and experience.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE