A prospective observational study of tracheal intubation in an emergency department in a 2300-bed hospital of a developing country in a one-year period.

OBJECTIVE: To assess the competency of physicians in the non-traumatic emergency department (ED) in intubating critically ill patients, to describe the methods, success rates and immediate complications after intubation in Siriraj Hospital.
METHOD: A one-year prospective observational study of endotracheal intubation in the ED of Siriraj Hospital, which has an annual census of 150 518 patients. Data were collected by each intubator at the time of each intubation for indications, success rates, use of drugs to facilitate intubation and immediate complications of tracheal intubation and the outcomes of patients. RESULT: A total of 757 patients underwent endotracheal attempts in the ED, including 176 (23.2%) patients in cardiopulmonary arrest; 754 (99.6%) of these were successfully intubated and 602 (79.5%) patients were successfully intubated at the first attempt. Three patients could not be intubated and underwent surgical airway management. In non-cardiac arrest patients, intubation by neuromuscular blocking agent was performed in 16 (2.75%) patients only, and all the intubators were anaesthesiologists. 396 (68.1%) patients were successfully intubated without using any drug. 285 (37.6%) patients were found to have a total of 341 complications.
CONCLUSION: At this institution, the majority of ED intubations were performed by residents and no drug was used. In this ED patients were intubated with a high success rate and a low rate of serious complications.