Association between repeated intubation attempts and adverse events in emergency departments: An analysis of a multicenter prospective observational study

Kohei Hasegawa, Kazuaki Shigemitsu, Yusuke Hagiwara, Takuyo Chiba, Hiroko Watase, Calvin A. Brown, David F.M. Brown

Research output: Contribution to journalArticlepeer-review

222 Citations (Scopus)

Abstract

Study objective: Although repeated intubation attempts are believed to contribute to patient morbidity, only limited data characterize the association between the number of emergency department (ED) laryngoscopic attempts and adverse events. We seek to determine whether multiple ED intubation attempts are associated with an increased risk of adverse events. Methods: We conducted an analysis of a multicenter prospective registry of 11 Japanese EDs between April 2010 and September 2011. All patients undergoing emergency intubation with direct laryngoscopy as the initial device were included. The primary exposure was multiple intubation attempts, defined as intubation efforts requiring greater than or equal to 3 laryngoscopies. The primary outcome measure was the occurrence of intubation-related adverse events in the ED, including cardiac arrest, dysrhythmia, hypotension, hypoxemia, unrecognized esophageal intubation, regurgitation, airway trauma, dental or lip trauma, and mainstem bronchus intubation. Results: Of 2,616 patients, 280 (11%) required greater than or equal to 3 intubation attempts. Compared with patients requiring 2 or fewer intubation attempts, patients undergoing multiple attempts exhibited a higher adverse event rate (35% versus 9%). After adjusting for age, sex, principal indication, method, medication, and operator characteristics, intubations requiring multiple attempts were associated with an increased odds of adverse events (odds ratio 4.5; 95% confidence interval 3.4 to 6.1). Conclusion: In this large Japanese multicenter study of ED patients undergoing intubation, we found that multiple intubation attempts were independently associated with increased adverse events.

Original languageEnglish
Pages (from-to)749-754.e2
JournalAnnals of Emergency Medicine
Volume60
Issue number6
DOIs
Publication statusPublished - 12-2012
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

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