Authors: Kate Barnett, Ross Freebairn, Saptarshi Mukerji, Christopher Poynter, Louise Poynton, Christopher White
Objective: To determine the rate of intubations carried out in Wellington Hospital Emergency Department (tertiary hospital), New Zealand, to provide a description of intubating habits of clinicians including operator experience and methods, and to determine the rate of complications.
Design: Eight month, retrospective, observational study.
Setting: Wellington Hospital Emergency Department(WHED).
Location: New Zealand.
Patients and participants: All patients intubated in the Emergency Department were included.
Interventions: None. Audit related activity.
Measurements and results: Over the eight months 57 intubations occurred. The most common indications for intubation were head injury with reduced Glasgow Coma Scale (GCS) and overdose (both 18.9%) followed by stroke, seizure and cardiac arrest (9.4-11.3%). Most intubations (46%) occurred between 8 a.m.-5 p.m. Eighty-two point seven percent of patients were intubated by ED doctors where seniority of team leader and intubating doctor varied according to the time of day. Intubation was consultant led 68.4% of the time before 5 p.m. and 40% of the time overnight. Airway checklist use was reported in 54.5% with formal airway assessment documented in 50%. Successful first pass occurred in 77.2% of cases. Difficult laryngoscopy (grade 3-4) was reported in 16.6% using direct laryngoscopy and 18.8% using videolaryngoscopy. All patients were successfully intubated orally in 3 attempts or less. Etomidate was drug of choice (54.7%). Seventeen point five percent experienced one or more complications. Trends towards less complications related to direct laryngoscopy compared to videolaryngoscopy and use of cricoid pressure associated with a higher complication rate were noted. However there were low numbers and statistical significance was not reached.
Conclusion: The first pass success rate for intubation was lower in comparison to other studies although adverse event rate was also lower. As a high-risk procedure, an incidence of seven intubations per month highlights the need for more diverse training opportunities for skills maintenance.