427 Evaluation of a Difficult Airway Educational Intervention on Resident Intubation Performance

Abstract

Study Objectives: Successful emergency airway management is a critical component of emergency medicine (EM) residency training. emergency medicine residency training leads to more timely intubation of patients in the emergency department (ED) and skills tend to increase with years of training (1,2). The so-called “difficult airway” (DA) can be defined using a variety of anatomic and physiologic criteria, and is commonly encountered in the ED (3). Successful management of this procedural subset is more likely with adequate training and preparation (4). No study has evaluated whether the introduction of a brief educational intervention and a predictive DA checklist improves certain characteristics of resident intubation. This research studies the effect of such an intervention on the number of intubation attempts, time to successful intubation, faculty involvement in the procedure, and use of adjunct devices. Methods: A retrospective chart review of all intubated patients at University Hospital (UH) in New Orleans was performed between September 2006 and June 2010. UH is a Level I trauma center affiliated with a fully accredited emergency medicine residency training program in an inner-city setting, with an ED patient volume of approximately 70,000 per year. Demographic, physiologic, and intubation procedural data was collected and recorded in a worksheet immediately after ED intubation. In July 2008, residents received a lecture on management strategies for the DA and participated in simulation exercises based on DA scenarios; a detailed checklist of DA predictors was added to the standard intubation form and was completed prior to each ED intubation. Overall procedural outcomes were compared pre- and post-intervention using generalized estimating equations and z statistics. Results: There were 266 successful intubations recorded in the pre-intervention period and 373 in the post-intervention period. In the post-intubation period, 33.2% of intubations met checklist criteria for a potential DA. Time from official procedural preparation to successful intubation did not vary between the 2 groups (11.6 minutes pre; 10.8 minutes post, p=0.30). There was no significant difference in the number of attempts made (1.4 pre; 1.3 post, p=0.44) or faculty intervention in the procedure (1.5% pre, 3.75% post, p=0.09). Intubations using an adjunct device increased post-intervention (8.2% TO 11.6%), and there was a significant difference in the number of successful intubations that were assisted by adjuncts (p=0.7449). Also, success on the second attempt was more likely if an adjunct was used (p=0.243). Conclusions: Difficult intubations, as defined by standard checklist, are relatively common occurrences in ED intubations. A brief, one-time DA educational module and standard checklist resulted in a few appreciable changes in emergency medicine resident intubations. Further research is needed to more clearly define the relationship between DA education and emergency medicine resident intubation performance.