Abstract
BackgroundEmergency airway management (AM) is a major key for successful resuscitation of critically ill non-traumatic (CINT) patients. Details of the AM of these patients in German emergency departments (ED) are unknown. This observational study describes epidemiology, airway techniques, success rates and complications of AM in CINT ED patients in the resuscitation room (RR).MethodsData was collected prospectively on adult CINT patients admitted to the RR of a single German university ED September 2014 to August 2015. Patient characteristics, out-of-hospital and in-hospital RR AM, complications and success rates were recorded using a self-developed airway registry form.ResultsDuring the study period 34,303 patients were admitted to the ED, out of those 21,074 patients for non-trauma emergencies. Suffering from severe acute life-threatening problems, 532 CINT patients were admitted to the RR. 150 (28.2%) CINT patients had received out-of-hospital AM. In 16 of these cases (10.7%) the inserted airway needed to be changed after RR admission (unrecognized oesophageal intubation: n = 2, laryngeal tube exchange: n = 14). 136 (25.6%) CINT patients without out-of-hospital AM received RR AM immediately after admission. The first-pass and overall success rate in the RR were 71 and 100%, respectively, and multiple intubation attempts were necessary in 29%. A lower Cormack/Lehane (C/L) grade was associated with less intubation attempts (C/L1/2 vs. 3/4: 1.2 ± 0.5 vs. 1.8 ± 1.2, p = 0.0002). Complication rate was 43%.ConclusionsOcEAN demonstrates the challenges of AM in CINT patients in a German ED RR. We propose a nation-wide ED airway registry to better track outcomes in the future.
Highlights
Emergency airway management (AM) is a major key for successful resuscitation of critically ill nontraumatic (CINT) patients
During the 12-month study period, 34,303 patients were admitted to the emergency departments (ED). 13,229 patients with 592 treated in the resuscitation room (RR) were excluded due to trauma as leading cause of admission. 21,074 patients were admitted for non-traumatic emergencies, with 537 patients directly admitted to the RR (2.54%)
The primary goal was to evaluate the out-of-hospital airway management performed by Emergency medical service (EMS) physicians at hospital arrival and to document the airway management in the RR setting in the ED in order to describe incidence, airway technique, success and complication rates
Summary
Emergency airway management (AM) is a major key for successful resuscitation of critically ill nontraumatic (CINT) patients. Details of the AM of these patients in German emergency departments (ED) are unknown This observational study describes epidemiology, airway techniques, success rates and complications of AM in CINT ED patients in the resuscitation room (RR). Ill patients frequently require airway management in the field or in the Emergency Department (ED) [1]. Studies have demonstrated that the number of intubation attempts is associated with increasing complication rates, the “first-pass intubation success” is an important concept in emergency airway management [6, 7]. The aim of this study is to evaluate airway management in critically ill patients in the resuscitation room (RR) of a German ED in order to describe incidence, devices, techniques, success and complication rates ED Airway registries exist in some countries (e.g., Australia [8], North America [9, 10], Korea [11], Japan [12]), data on emergency airway management in German EDs are still missing.
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