463: First-Attempt Success Rate of Endotracheal Intubation Performed by Air Medical Providers In Various Settings

Abstract

Endotracheal intubation (ETI) in the air medical setting can be challenging, yet is commonly required of air medical providers. Understanding ETI failure rate and associated factors could improve training and increase ETI success rate in the air medical setting. We endeavored to calculate overall first-attempt success rates for air medical providers performing ETI in various settings and identify factors that may affect first-attempt success rate. Patients were enrolled in a prospective observational Air Care Airway Registry from January 2000 to March 2002, and from April 2004 to May 2007. Patients requiring advanced airway management performed by a member of the air medical flight crew (flight registered nurse and flight physician) were eligible for enrollment. The flight physician was most often an emergency medicine resident post-graduate year (PGY) 2-4, but on occasion was an attending emergency physician. An additional PGY-1 emergency physician was present on some flights. Cases were included in this analysis if the site where advanced airway management was performed, and the crew member performing the procedure, was recorded. The Chi Square or Fisher's Exact test was used to compare differences in categorical variables and Student's t-tests were used for continuous variables. From 305 patients enrolled, 291 patients were included in this analysis. Mean age was 36 (SD 21), mean weight was 79 kg (SD 27) and 70% were male. The first crew member attempting advanced airway management was most often a PGY-2 physician (51%) or a flight nurse (25%). The first advanced airway management attempt most often occurred in the ambulance (54%). Overall, the success rate of ETI on first attempt was 69.2% [95CI 62.3% to 73.3%]; 96.6% of patients were intubated in less than four attempts and there were up to 6 attempts in one case. Success on first attempt did not vary by provider type overall (p=0.076), or when ETI was attempted in an ambulance (p=0.392), at the scene (p=0.975), or in the helicopter (p=0.762). PGY-1 physicians were less likely to have first attempt success in an outside hospital (p=0.021). While the first attempt success rate appeared higher in a hospital setting, this did not reach significance (p=0.962), and there was no statistical evidence for differing success rates across the site of first attempt. Weight and age were not associated with initial intubation success. Males were more likely than females to require multiple airway management attempts (p =0.016). Table 1. First intubation attempt success rate by location.Tabled 1 The success of the first intubation attempt for air medical providers in this single center registry was similar to that found in other studies. The success rate appears consistent regardless of who attempts the procedure or where the attempt is made, although site and provider are not independent. Males required multiple intubation attempts more often than females; elucidating why this occurs requires further exploration of possible confounders.