BACKGROUND: Difficult airway predictors (DAPs) are associated with failed endotracheal intubation (ETI) in the emergency department (ED). However, little is known about the relationship between DAPs and failed prehospital ETI. OBJECTIVE: Our aim was to determine the prevalence of common DAPs among failed prehospital intubations. METHODS: We reviewed a quality-improvement database, including all cases of ETI in a single ED, over 3 years. Failed prehospital (FP) ETI was defined as a case brought to the ED after attempted prehospital ETI, but bag-valve-mask ventilation, need for a rescue airway (supraglottic device, cricothyrotomy, etc.), or esophageal intubation was discovered at the ED. Physicians performing ETI evaluated each case for the presence of DAPs, including blood/emesis, facial/neck trauma, airway edema, spinal immobilization, short neck, and tongue enlargement. RESULTS: There were a total of 1377 ED ETIs and 161 had an FP-ETI (11.8%). Prevalence of DAPs in cases with FP-ETI was obesity 13.0%, large tongue 18.0%, short neck 13%, small mandible 4.3%, cervical immobility 49.7%, blood in airway 57.8%, vomitus in airway 23.0%, airway edema 12.4%, and facial or neck trauma 32.9%. The number of cases with FP-ETI and 0, 1, 2, 3, or 4 or more DAPs per case was 22 (13.6%), 43 (26.7%), 23 (24.3%), 42 (26.1%), and 31 (19.3%), respectively. CONCLUSIONS: DAPs are common in cases of FP-ETI. Some of these factors may be associated with FP-ETI. Additional study is needed to determine if DAPs can be used to identify patients that are difficult to intubate in the field.
BACKGROUND: Difficult airway predictors (DAPs) are associated with failed endotracheal intubation (ETI) in the emergency department (ED). However, little is known about the relationship between DAPs and failed prehospital ETI. OBJECTIVE: Our aim was to determine the prevalence of common DAPs among failed prehospital intubations. METHODS: We reviewed a quality-improvement database, including all cases of ETI in a single ED, over 3 years. Failed prehospital (FP) ETI was defined as a case brought to the ED after attempted prehospital ETI, but bag-valve-mask ventilation, need for a rescue airway (supraglottic device, cricothyrotomy, etc.), or esophageal intubation was discovered at the ED. Physicians performing ETI evaluated each case for the presence of DAPs, including blood/emesis, facial/neck trauma, airway edema, spinal immobilization, short neck, and tongue enlargement. RESULTS: There were a total of 1377 ED ETIs and 161 had an FP-ETI (11.8%). Prevalence of DAPs in cases with FP-ETI was obesity 13.0%, large tongue 18.0%, short neck 13%, small mandible 4.3%, cervical immobility 49.7%, blood in airway 57.8%, vomitus in airway 23.0%, airway edema 12.4%, and facial or neck trauma 32.9%. The number of cases with FP-ETI and 0, 1, 2, 3, or 4 or more DAPs per case was 22 (13.6%), 43 (26.7%), 23 (24.3%), 42 (26.1%), and 31 (19.3%), respectively. CONCLUSIONS:DAPs are common in cases of FP-ETI. Some of these factors may be associated with FP-ETI. Additional study is needed to determine if DAPs can be used to identify patients that are difficult to intubate in the field.
Authors: Balázs Poros; Thomas Irlbeck; Philipp Probst; Alexander Volkmann; Philipp Paprottka; Wolfgang Böcker; Michael Irlbeck; Thomas Weig Journal: Eur J Trauma Emerg Surg Date: 2019-11-19 Impact factor: 3.693
Authors: Hendrik Eismann; Lion Sieg; Nicola Etti; Lars Friedrich; Christian Schröter; Philipp Mommsen; Christian Krettek; Christian Zeckey Journal: Eur J Med Res Date: 2017-08-10 Impact factor: 2.175
Authors: Christopher W Root; Oscar J L Mitchell; Russ Brown; Christopher B Evers; Jess Boyle; Cynthia Griffin; Frances Mae West; Edward Gomm; Edward Miles; Barry McGuire; Anand Swaminathan; Jonathan St George; James M Horowitz; James DuCanto Journal: Resusc Plus Date: 2020-05-21
Authors: In Kyong Yi; Hyun Jeong Kwak; Kyung Cheon Lee; Ji Hyea Lee; Sang Kee Min; Jong Yeop Kim Journal: Eur J Med Res Date: 2020-08-20 Impact factor: 2.175