Abstract
Objective: Emergency department (ED) intubation personnel and practices have changed
dramatically in recent decades, but have been described only in single-center studies.
We sought to better describe ED intubations by using a multi-center registry. Methods:
We established a multi-center registry and initiated surveillance of a longitudinal,
prospective convenience sample of intubations at 31 EDs. Clinicians filled out a data
form after each intubation. Our main outcome measures were descriptive. We characterized
indications, methods, medications, success rates, intubator characteristics, and associated
event rates. We report proportions with 95% confidence intervals and chi-squared testing;
p-values < 0.05 were considered significant. Results: There were 8937 encounters recorded
from September 1997 to June 2002. The intubation was performed for medical emergencies
in 5951 encounters (67%) and for trauma in 2337 (26%); 649 (7%) did not have a recorded
mechanism or indication. Rapid sequence intubation was the initial method chosen in
6138 of 8937 intubations (69%) and in 84% of encounters that involved any intubation
medication. The first method chosen was successful in 95%, and intubation was ultimately
successful in 99%. Emergency physicians performed 87% of intubations and anesthesiologists
3%. Several other specialties comprised the remaining 10%. One or more associated
events were reported in 779 (9%) encounters, with an average of 12 per 100 encounters.
No medication errors were reported in 6138 rapid sequence intubations. Surgical airways
were performed in 0.84% of all cases and 1.7% of trauma cases. Conclusion: Emergency
physicians perform the vast majority of ED intubations. ED intubation is performed
more commonly for medical than traumatic indications. Rapid sequence intubation is
the most common method of ED intubation.
Keywords
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Article info
Publication history
Published online: April 30, 2010
Accepted:
February 17,
2010
Received in revised form:
January 23,
2010
Received:
September 22,
2009
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
