102 Association Between Patients' Characteristics and Peri-Intubation Adverse Events in the Emergency Department

Abstract

To evaluate patient characteristics and their association with adverse events in emergency department (ED) intubations. Twenty-two academic emergency departments in the United States recorded 5,071 ED intubations in the National Emergency Airway Registry (NEAR) using a Web-based tool, StudyTRAX in 2016 (additional data on about 7,500 ED intubations for 2017 are expected in late April 2018). Only emergency departments who met the 90% compliance requirements were included in the study. We discuss associations between patient characteristics and adverse events. The rates of certain adverse events noted in prior studies of intubation have changed. Esophageal intubations were a significant adverse event in past registry data. Overall adverse event rates in this review were found in 13% of intubations. The most common adverse events were hypoxia (8%) and hypotension (4%). Several patient characteristics were noted to have a significant association with adverse events. The highest rates of any adverse events were found in patients in the following categories: morbid obesity (22.13%), presence of airway obstruction (20.79%), and predicted difficult airway (18.17%). Hypoxia was found most commonly in patients with predicted difficult airway (15.8%) and with morbid obesity (14.9%). Hypotension was seen predominantly in patients over 75 years of age (7%) and in the morbidly obese (5.5%). Interestingly, predicted difficult airway and thin body habitus appeared to be equally associated with hypotension (4.4%). This registry data shows hypoxia and hypotension to be the most common adverse events in ED intubations. The patient characteristics linked to the highest rates of any adverse events were found to be morbid obesity, presence of airway obstruction and predicted difficult airway. Further research in this area may help elucidate the most appropriate way to decrease the occurrence of adverse events.