Emergency Medicine Postgraduate Year, Laryngoscopic View, and Endotracheal Tube Placement Success

Abstract

ObjectivePrior work has found first-attempt success improves by emergency medicine (EM) postgraduate year (PGY). However, the association between PGY and laryngoscopic view – a key step in successful intubation – is unknown. We examined the relationship between PGY, laryngoscopic view [i.e., Cormack-Lehane view (CL)], and first-attempt success. MethodsWe performed a retrospective analysis of the National Emergency Airway Registry (NEAR), including adult intubations by EM PGY 1-4 resident physicians. We used inverse probability weighting with propensity scores to balance confounders. We used weighted regression and model comparison to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI) between PGY and CL view, test the interaction between PGY and CL view on first-attempt success, and examine the effect modification of CL view on the association between PGY and first-attempt success. ResultsAfter exclusions, we included 15,453 first attempts. Compared to PGY 1, the aORs for a higher CL grade did not differ from PGY 2 (1.01; 0.49 to 2.07), PGY 3 (0.92; 0.31 to 2.73), or PGY 4 (0.80; 0.31 to 2.04) groups. The interaction between PGY and CL view was significant (p-interaction <0.001). In patients with CL grade 3 or 4, the aORs for first-attempt success were higher for PGY 2 (1.80; 1.17 to 2.77), PGY 3 (2.96; 1.66 to 5.27) and PGY 4 (3.10; 1.60 to 6.00) groups relative to PGY 1. ConclusionCompared to PGY 1, PGY 2, 3, and 4 resident physicians obtained similar CL views, but had higher first-attempt success when obtaining a grade 3 or 4 view.