The Success Rate of Endotracheal Intubation in the Emergency Department of Tertiary Care Hospital in Ethiopia, One-Year Retrospective Study.

Ayalew Zewdie,Selam Alemayehu,Tesfaye Getachew,Menbeu Sultan,Dejene Tagesse,Edward A. Panacek

doi:10.1155/2021/9590859

Abstract

Background Emergency medical care starts with airway assessment and intervention management. Endotracheal intubation is the definitive airway management in the emergency department (ED) for patients requiring a definitive airway. Successful first pass is recommended as the main objective of emergency intubation. There exists no published research regarding the success rates or complications that occur within Ethiopian hospitals emergency department intubation practice. Objective This study aimed to assess the success rate of emergency intubations in a tertiary hospital, Addis Ababa, Ethiopia. Methodology. This was a single institute retrospective documentation review on intubated patients from November 2017 to November 2018 in the emergency department of Addis Ababa Burn Emergency and Trauma Hospital. All intubations during the study period were included. Data were collected by trained data collectors from an intubation documentation sheet. Result Of 15,933 patients seen in the department, 256 (1.6%) patients were intubated. Of these, 194 (74.9%) were male, 123 (47.5%) sustained trauma, 65 (25.1%) were medical cases, and 13(5%) had poisoning. The primary indications for intubation were for airway protection (160 (61.8%)), followed by respiratory failure (72(27.8%)). One hundred and twenty-nine (49.8%) had sedative-only intubation, 110 (42.5%) had rapid sequence intubation, and 16 (6.2%) had intubation without medication. The first-pass success rate in this sample was 70.3% (180/256), second-pass 21.4% (55/256), and third-pass 7.4% (19/256), while the overall success rate was 99.2% (254/256). Hypoxia was the most common complication. Conclusion The intubation first-pass success rate was lower than existing studies, but the overall intubation success rate was satisfactory.

Highlights

Emergency medical care starts with airway assessment and intervention management
Study from the anesthesia literature showed that repeated attempt of intubations leads to a higher complication rate [7]. ere are limited data from emergency medicine in the developing world about the success of airway management in the emergency room [8]
All intubations in the emergency department (ED) were documented by ED nurse using a purpose designed documentation sheet (Annex-1) as close to the time of intubation as possible. e provider who intubated the patient signed the form after data were filled by the nurse. e documentation form was used by the staff during intubation as a standard protocol of the hospital. We developed another form (Annex-2) for our analysis which includes age, sex, diagnosis, indication for intubation, anesthetic agents used for intubation, pre- and postintubation vital signs (V/s), immediate complications, and the number of intubation attempts, the intubation personnel, and outcome of intubation

Summary

Introduction

Endotracheal intubation is the definitive airway management in the emergency department (ED) for patients requiring a definitive airway. RSI performed in critically ill and injured patients in the emergency room has a high risk of failed intubation and other complications than that in the operating room [4, 5]. In North America, surveillance studies demonstrated that ED intubations by emergency medicine residents and physicians, largely using a rapid sequence intubation technique, can be performed safely and with high levels of success [6].

Results

Conclusion