371 Emergency Physician First Pass Intubation Success Is Similar in Inpatient Settings and the Emergency Department

Abstract

Emergency medicine (EM) physicians (EPs) are sometimes called to perform tracheal intubation for critically ill patients outside of the emergency department (ED), for example as part of a hospital airway or medical emergency team. Differences in patient characteristics or intubation context in the inpatient units (ie, cognitive, team-based, or environmental challenges) may be associated with changes in the safety and success of tracheal intubation, as compared to intubations performed in the ED. Our objective was to characterize intubation performance for EPs in the ED compared to inpatient settings. We hypothesized that first-pass success rates for EPs in different settings would not be significantly different. We performed a retrospective, single center study of adult patients intubated at Hennepin County Medical Center in the ED, Intensive Care Units (ICU), and inpatient units between March 2019 and April 2021. Patients intubated in these settings by a non emergency physician were excluded. Clinical data and patient variables were collected from the electronic health record (EHR). Patient demographics, first attempt success rate, and hospital mortality were captured. The primary outcome, successful intubation on the first laryngoscopy attempt across settings, was evaluated using an unadjusted chi square test. The first attempt success rate for intubations performed by emergency physicians was 95.5% (1683/1763) in the ED, 94.8% (1072/1131) in the ICU, and 94.6% (156/165) in inpatient non-ICU settings. These differences did not reach statistical significance (p=0.66 by chi square test). Mean age was 47.1 years in the ED, 50.5 years in the ICU, and 46.8 years in inpatient non-ICU settings. The most common primary diagnoses for all settings were altered mental status, cardiac arrest, and sepsis. Hospital mortality was significantly different (p < 0.001) for patients intubated by emergency physicians in the different settings, with a rate of 15% for ED patients, 20% in the ICU, and 24% in inpatient non-ICU settings. Emergency physicians achieved >94% first pass intubation success among critically ill patients regardless of hospital setting, and the rates of first pass success in the ED, ICU, and non-ICU inpatient units were similar. The first attempt success rate in this study is similar to previous ED studies, however is higher than the rate in previous descriptions in the ICU setting. This suggests that EPs perform intubations outside of the emergency department with a high level of performance. Limitations of this study include the use of EHR procedural documentation to evaluate first attempt success rate. Further research should include data collection by trained observers and in multiple institutions.