Techniques and outcomes of emergency airway management in Japan: An analysis of two multicentre prospective observational studies, 2010–2016

Objectives Continuous surveillance of emergency airway management practice is imperative in improving quality of care and patient safety. We aimed to investigate the changes in the practice of emergency airway management and the related outcomes in the emergency departments (EDs) in Japan. Methods We conducted an analysis of the data from two prospective, observational, multicentre registries of emergency airway management—the Japanese Emergency Airway Network (JEAN)-1 and -2 Registries from April 2010 through May 2016. Results We recorded 10,927 ED intubations (capture rate, 96%); 10,875 paediatric and adult patients were eligible for our analysis. The rate of rapid sequence intubation (RSI) use as the initial intubation method significantly increased from 28% in 2010 to 53% in 2016 (P_trend = 0.03). Likewise, the rate of video laryngoscope (VL) use as the first intubation device increased significantly from 2% in 2010 to 40% in 2016 (P_trend < 0.001), with a significant decrease in the rate of direct laryngoscope use from 97% in 2010 to 58% in 2016 (P_trend < 0.001). Concurrent with these changes, the overall first-attempt success rate also increased from 68% in 2010 to 74% in 2016 (P_trend = 0.02). By contrast, the rate of adverse events did not change significantly over time (P_trend = 0.06). Conclusion By using data from two large, multicentre, prospective registries, we characterised the current emergency airway management practice, and identified their changes in Japan. The data demonstrated significant increases in the rate of RSI and VL use on the first attempt and the first-attempt success rate over the 6-year study period.