Comparison of Drug-Assisted Tracheal Intubation Using Benzodiazepines and Induction Agents for First-Pass Intubation Success in Emergency Airway Management: A Retrospective Cohort Study

Abstract

Objective: To determine first-pass intubation success between benzodiazepines and induction agents in adult patients who underwent drug-assisted intubation in the emergency department (ED). Materials and Methods: A retrospective chart review observational study collected the data of patients who underwent drug-assisted intubation in the ED of a university teaching hospital between January 1, 2021 and August 31, 2022. Two hundred seven patients were enrolled in the present study. The benzodiazepine and induction agent groups were compared in terms of baseline characteristics, and clinical management. Each benzodiazepine and induction agent were compared in first-pass intubation success, time to intubation success, adverse events, and 24-hour mortality. Results: Of the 207 patients included in the present study, 35 patients used benzodiazepine, and 172 patients used induction agents. The two groups had no differences in baseline characteristics. The first-pass intubation success rate was not significantly different among the medications with 90% in nine diazepam patients, 92% in 23 midazolam patients, 89.8% in 79 etomidate patients, and 94% in 79 propofol patients (p=0.553). Complications associated with intubation included hypotension, desaturation, tachycardia, bradycardia, arrhythmia, cardiac arrest, and pneumonia. No differences in 24-hour survival were observed. Conclusion: The sedative medications used during drug-assisted intubation should be chosen based on patient comorbidities and characteristics, as well as physician preferences and experiences. There were no differences between the benzodiazepine and induction agent groups in terms of first-pass intubation success, adverse events, or 24-hour survival. The use of benzodiazepines in settings with limited resources may be considered.