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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Airway management practices in emergency medicine residencies.Am J Emerg Med. 1995; 13: 501-504
- Emergency procedures important to the training of emergency medicine residents: who performs them in the emergency department?.Acad Emerg Med. 1995; 2: 630-633
- Airway management in the emergency department: a one-year study of 610 tracheal intubations.Ann Emerg Med. 1998; 31: 325-332
- Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period.Acad Emerg Med. 1999; 6: 31-37
- Complications of emergency intubation with and without paralysis.Am J Emerg Med. 1999; 17: 141-143
- The failed intubation attempt in the ED: analysis of prevalence, rescue techniques and personnel.J Emerg Med. 2002; 23: 131-140
- Airway management by US and Canadian emergency medicine residents: a multi-center analysis of more than 6,000 endotracheal intubation attempts.Ann Emerg Med. 2005; 46: 328-336
- NEAR misses: an analysis of unreported intubations.Ann Emerg Med. 2007; 50: S5
- Emergency airway management—experience of a tertiary hospital in South-East Asia.Resuscitation. 2004; 61: 349-355
Published online: April 30, 2010
Accepted: February 17, 2010
Received in revised form: January 23, 2010
Received: September 22, 2009
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.