Yukari Goto1, Hiroko Watase2, Calvin A Brown3, Shigeki Tsuboi4, Takashiro Kondo5, David F M Brown6, Kohei Hasegawa6. 1. Department of Emergency Medicine Nagoya Ekisaikai Hospital Nagoya Japan. 2. Department of Public Health and Preventive Medicine Oregon Health and Science University Portland Oregon USA. 3. Department of Emergency Medicine Brigham and Women's Hospital Boston Massachusetts USA. 4. Department of Emergency Medicine Ogaki Municipal Hospital Ogaki Japan. 5. Department of Healthcare Epidemiology Kyoto University School of Medicine and Public Health Kyoto Japan. 6. Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA.
Abstract
AIM: To examine the success rates of emergency department airway management by resident physicians in Japan. METHODS: We conducted an analysis of a multicentre prospective registry (Japanese Emergency Airway Network Registry) of 13 academic and community emergency departments in Japan. We included all patients who underwent emergency intubation performed by postgraduate year 1 to 5 transitional or emergency medicine residents (resident physicians) between April 2010 and August 2012. Outcome measures were success rates by the first intubator, and by rescue intubator, according to the level of training. RESULTS: We recorded 4,094 intubations (capture rate, 96%); 2,800 attempts (2,800/4,094; 68%; 95% confidence interval (CI), 67%-70%) were initially performed by resident physicians. Overall success rate on the first attempt was 63% (1,767/2,789; 95%CI, 61%-64%); the rate improved over the first 3 years of training before reaching a plateau (P trend < 0.001). Success rate by the first intubator was 78% (2,185/2,800; 95%CI, 76%-79%); the rate steadily improved as level of training increased (P trend < 0.001). Of 597 failed intubation attempts by the first intubator, 41% (247/597; 95%CI, 37%-45%) of rescue attempts were performed by resident physicians. Success rate on the first rescue attempt was 76% (187/247; 95%CI, 70%-81%), and success rate by first rescue intubator was 89% (220/247; 95%CI, 85%-93%). These rates on rescue attempts steadily improved as level of training increased (both P trend < 0.001). Intubations were ultimately successful in 2,778 encounters (99.6%). CONCLUSION: In this multicentre study characterizing emergency airway management across Japan, we observed that emergency department intubations were primarily managed by resident physicians with acceptably high success rates overall.
AIM: To examine the success rates of emergency department airway management by resident physicians in Japan. METHODS: We conducted an analysis of a multicentre prospective registry (Japanese Emergency Airway Network Registry) of 13 academic and community emergency departments in Japan. We included all patients who underwent emergency intubation performed by postgraduate year 1 to 5 transitional or emergency medicine residents (resident physicians) between April 2010 and August 2012. Outcome measures were success rates by the first intubator, and by rescue intubator, according to the level of training. RESULTS: We recorded 4,094 intubations (capture rate, 96%); 2,800 attempts (2,800/4,094; 68%; 95% confidence interval (CI), 67%-70%) were initially performed by resident physicians. Overall success rate on the first attempt was 63% (1,767/2,789; 95%CI, 61%-64%); the rate improved over the first 3 years of training before reaching a plateau (P trend < 0.001). Success rate by the first intubator was 78% (2,185/2,800; 95%CI, 76%-79%); the rate steadily improved as level of training increased (P trend < 0.001). Of 597 failed intubation attempts by the first intubator, 41% (247/597; 95%CI, 37%-45%) of rescue attempts were performed by resident physicians. Success rate on the first rescue attempt was 76% (187/247; 95%CI, 70%-81%), and success rate by first rescue intubator was 89% (220/247; 95%CI, 85%-93%). These rates on rescue attempts steadily improved as level of training increased (both P trend < 0.001). Intubations were ultimately successful in 2,778 encounters (99.6%). CONCLUSION: In this multicentre study characterizing emergency airway management across Japan, we observed that emergency department intubations were primarily managed by resident physicians with acceptably high success rates overall.
Authors: Ronald C Sanders; John S Giuliano; Janice E Sullivan; Calvin A Brown; Ron M Walls; Vinay Nadkarni; Akira Nishisaki Journal: Pediatrics Date: 2013-02-11 Impact factor: 7.124
Authors: Taichi Imamura; Calvin A Brown; Hisashi Ofuchi; Hiroshi Yamagami; Joel Branch; Yusuke Hagiwara; David F M Brown; Kohei Hasegawa Journal: Am J Emerg Med Date: 2012-10-18 Impact factor: 2.469