English

Abstract

BACKGROUND First-pass success is the successful intubation on the first attempt. It is the desired goal of emergency intubation and failure to achieve it may increase the risk of adverse effects. With failure of first pass intubation, life-threatening complications occur, commonly in critically ill patients. The aim of this study is to determine the association between the success of first-pass intubation and frequency of adverse events during endotracheal intubation. METHODS A cross sectional analytical study was done in a tertiary care hospital between October 2016 and October 2017. 100 failed first-pass intubation cases and 100 successful first-pass intubation cases were evaluated for factors associated with failed first-pass intubation and frequency of adverse events following intubation. RESULTS The groups were matched with respect to gender, induction agent use, fentanyl use and type of laryngoscope used. Mean age in failed first-pass intubation group was 5.61 years higher than subjects in successful first-pass intubation group (P = 0.016). Proportion of subjects with difficult airway was 19 % in failed first-pass intubation group and 3 % in successful first-pass intubation (P < 0.001). Failed first-pass intubation cases had higher frequency of adverse events like oesophageal intubation (9 % vs. 0 %), aspiration (7 % vs. 1 %), cuff leakage (2 % vs. 0 %) and hypotension (7 % vs. 1 %) compared to successful first-pass intubation cases. CONCLUSIONS The frequency of adverse events was high in failed first-pass intubation. Older age and presence of difficult airway were factors significantly associated with failed first-pass intubation. KEYWORDS First Pass Intubation, First-Pass Success, Adverse Events, Emergency Department, Failed First Attempt, Endotracheal Intubation