Abstract
BackgroundEmergent airway management outside of the operating room is a high-risk procedure. Limited data exists about the indication and physiologic state of the patient at the time of intubation, the location in which it occurs, or patient outcomes afterward.MethodsWe retrospectively collected data on all emergent airway management interventions performed outside of the operating room over a 6-month period. Documentation included intubation performance, and intubation related complications and mortality. Additional information including demographics, ASA-classification, comorbidities, hospital-stay, ICU-stay, and 30-day in-hospital mortality was obtained.Results336 intubations were performed in 275 patients during the six-month period. The majority of intubations (n = 196, 58%) occurred in an ICU setting, and the rest 140 (42%) occurred on a normal floor or in a remote location. The mean admission ASA status was 3.6 ± 0.5, age 60 ± 16 years, and BMI 30 ± 9 kg/m2. Chest X-rays performed immediately after intubation showed main stem intubation in 3.3% (n = 9). Two immediate (within 20 min after intubation) intubation related cardiac arrest/mortality events were identified. The 30-day in-hospital mortality was 31.6% (n = 87), the overall in-hospital mortality was 37.1% (n = 102), the mean hospital stay was 22 ± 20 days, and the mean ICU-stay was 14 days (13.9 ± 0.9, CI 12.1–15.8) with a 7.3% ICU-readmission rate.ConclusionPatients requiring emergent airway management are a high-risk patient population with multiple comorbidities and high ASA scores on admission. Only a small number of intubation-related complications were reported but ICU length of stay was high.
Highlights
Emergent airway management outside of the operating room is a high-risk procedure
This included code blue, rapid response (RRT), Anaesthesia STAT, level 1 trauma, or elective intubation request which were defined as: Code blue was announced for cardiopulmonary arrest or other life-threatening events
Intubation performance and difficult intubation In this study, we found 88.1% of the intubations were accomplished on the first attempt
Summary
Emergent airway management outside of the operating room is a high-risk procedure. Limited data exists about the indication and physiologic state of the patient at the time of intubation, the location in which it occurs, or patient outcomes afterward. Emergent airway management is required outside of the operating room (OR) in every hospital setting. It is an inherently higher risk procedure when compared to controlled OR settings [1]. Intubations outside of the OR are performed under less ideal. Patients requiring emergent intubation are frequently hemodynamically unstable, hypoxic, and rarely NPO. Physical exam, and information handoff by the primary care team is often incomplete or limited in an emergent airway setting. There is limited time to perform an adequate airway exam
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