FIRST PASS SUCCESS DURING AIRWAY MANAGEMENT BY CRITICAL CARE PHYSICIANS OUTSIDE OF AN ICU

Abstract

SESSION TITLE: Critical Care 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: There is limited data available regarding the airway management of patients by critical care doctors outside of an intensive care unit (OICU) or emergency department. Our goal is to describe the population of patients intubated by critical care physicians OICU at our institution and to see if the rate of first pass success (FPS) is different from inside of an ICU (IICU). We hypothesized that at our large academic medical center, the rate of FPS during intubations done by critical care providers would be lower OICU than IICU. METHODS: We performed a retrospective cohort study of all intubations done by the critical care service at Montefiore Medical Center between July 1st, 2016 and May 1st, 2017. Intubation notes and associated patient data were identified using clinical looking glass (CLG) (Clinical Analytics®, NY, NY). For patients who had multiple intubations performed, only the first intubation was included. Patient characteristics were compared with chi-square testing for categorical variables and either a t-test or Wilcoxon rank-sum test for continuous and discrete variables, respectively. To compare FPS between patients intubated IICU and OICU we performed logistic regression with adjustment for age, gender, diagnosis of obstructive sleep apnea (OSA), body mass index (BMI), method of intubation, operator rank as non-attending and operator background as non-anesthesia trained. RESULTS: 762 intubations (384 OICU, 378 IICU) met inclusion criteria and were examined in the final analysis. Patients who were intubated OICU were found to be older (67.8 vs. 62.8 years; p < 0.001), have equal likelihood of a diagnosis of OSA (12.2% vs. 14.0%; p = 0.47), have similar BMI (33.8 vs. 29.7; p = 0.48) and have higher Charlson co-morbidity index (median 5 vs. 4; p = 0.01). Patients OICU were more likely to be intubated for circulatory arrest (27.6% vs. 7.14%; p < 0.001) and have higher mortality within 24 hours of the intubation (14.6% vs. 5.56%; p < 0.001). OICU intubations were more likely to be done by a trainee (88.8% vs. 77.8%; p < 0.001) and less likely to be done by a physician with anesthesia training (4.2% vs. 9.5%; p <0.001). Unadjusted FPS was not different between patients OICU and IICU (73.7% vs. 71.4%; p = 0.48, odds ratio (OR), 1.12, [95% CI, 0.82-1.54]). After multivariate adjustment, FPS was also not different between the 2 patient groups (OR, 1.10; 95% CI, 0.79-1.54). CONCLUSIONS: At our institution we found that patients intubated by the critical care service OICU were more likely to be older and have higher co-morbidity than those patients intubated IICU. The rate of first pass success was not different between the two groups. CLINICAL IMPLICATIONS: Critically ill patients can be intubated by critical care specialists irrespective of hospital location. DISCLOSURES: No relevant relationships by Lewis Eisen, source=Web Response No relevant relationships by Nader Esfahani, source=Admin input No relevant relationships by Daniel Fein, source=Web Response No relevant relationships by Fiore Mastroianni, source=Web Response No relevant relationships by Ariel Shiloh, source=Web Response