Association of airway obstruction with first-pass success and intubation-related adverse events in the emergency department: multicenter prospective observational studies
BackgroundAirway obstruction is a relatively rare but critical condition that requires urgent intervention in the emergency department (ED). The present study aimed to investigate the association of airway obstruction with first-pass success and intubation-related adverse events in the ED.MethodsWe...
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| Language: | English |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1199750/full |
| _version_ | 1797654325695086592 |
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| author | Jin Takahashi Jin Takahashi Tadahiro Goto Shigeki Fujitani Hiroshi Okamoto Yusuke Hagiwara Hiroko Watase Kohei Hasegawa the Japanese Emergency Medicine Network Investigators |
| author_facet | Jin Takahashi Jin Takahashi Tadahiro Goto Shigeki Fujitani Hiroshi Okamoto Yusuke Hagiwara Hiroko Watase Kohei Hasegawa the Japanese Emergency Medicine Network Investigators |
| author_sort | Jin Takahashi |
| collection | DOAJ |
| description | BackgroundAirway obstruction is a relatively rare but critical condition that requires urgent intervention in the emergency department (ED). The present study aimed to investigate the association of airway obstruction with first-pass success and intubation-related adverse events in the ED.MethodsWe analyzed data from two prospective multicenter observational studies of ED airway management. We included adults (aged ≥18 years) who underwent tracheal intubation for non-trauma indications from 2012 through 2021 (113-month period). Outcome measures were first-pass success and intubation-related adverse events. We constructed a multivariable logistic regression model adjusting for age, sex, modified LEMON score (without airway obstruction), intubation methods, intubation devices, bougie use, intubator’s specialty, and ED visit year with accounting for patients clustering within the ED.ResultsOf 7,349 eligible patients, 272 (4%) underwent tracheal intubation for airway obstruction. Overall, 74% of patients had first-pass success and 16% had intubation-related adverse events. The airway obstruction group had a lower first-pass success rate (63% vs. 74%; unadjusted odds ratio [OR], 0.63; 95% CI, 0.49–0.80), compared to the non-airway obstruction group. This association remained significant in the multivariable analysis (adjusted OR 0.60, 95%CI 0.46–0.80). The airway obstruction group also had a significantly higher risk of adverse events (28% vs. 16%; unadjusted OR, 1.93; 95% CI, 1.48–2.56, adjusted OR, 1.70; 95% CI, 1.27–2.29). In the sensitivity analysis using multiple imputation, the results remained consistent with the main results: the airway obstruction group had a significantly lower first-pass success rate (adjusted OR, 0.60; 95% CI, 0.48–0.76).ConclusionBased on these multicenter prospective data, airway obstruction was associated with a significantly lower first-pass success rate and a higher intubation-related adverse event rate in the ED. |
| first_indexed | 2024-03-11T16:57:49Z |
| format | Article |
| id | doaj.art-e3b9517294b0445e909987a543c7cade |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-11T16:57:49Z |
| publishDate | 2023-05-01 |
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| series | Frontiers in Medicine |
| spelling | doaj.art-e3b9517294b0445e909987a543c7cade2023-10-20T13:27:54ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-05-011010.3389/fmed.2023.11997501199750Association of airway obstruction with first-pass success and intubation-related adverse events in the emergency department: multicenter prospective observational studiesJin Takahashi0Jin Takahashi1Tadahiro Goto2Shigeki Fujitani3Hiroshi Okamoto4Yusuke Hagiwara5Hiroko Watase6Kohei Hasegawa7the Japanese Emergency Medicine Network InvestigatorsDepartment of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, JapanDepartment of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, JapanTXP Medical Co., Ltd., Bunkyo, Tokyo, JapanDepartment of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, JapanDepartment of Critical Care Medicine, St. Luke's International Hospital, Chuo-ku, Tokyo, JapanDepartment of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children’s Medical Center, Fuchu, Tokyo, JapanDepartment of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, JapanDepartment of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United StatesBackgroundAirway obstruction is a relatively rare but critical condition that requires urgent intervention in the emergency department (ED). The present study aimed to investigate the association of airway obstruction with first-pass success and intubation-related adverse events in the ED.MethodsWe analyzed data from two prospective multicenter observational studies of ED airway management. We included adults (aged ≥18 years) who underwent tracheal intubation for non-trauma indications from 2012 through 2021 (113-month period). Outcome measures were first-pass success and intubation-related adverse events. We constructed a multivariable logistic regression model adjusting for age, sex, modified LEMON score (without airway obstruction), intubation methods, intubation devices, bougie use, intubator’s specialty, and ED visit year with accounting for patients clustering within the ED.ResultsOf 7,349 eligible patients, 272 (4%) underwent tracheal intubation for airway obstruction. Overall, 74% of patients had first-pass success and 16% had intubation-related adverse events. The airway obstruction group had a lower first-pass success rate (63% vs. 74%; unadjusted odds ratio [OR], 0.63; 95% CI, 0.49–0.80), compared to the non-airway obstruction group. This association remained significant in the multivariable analysis (adjusted OR 0.60, 95%CI 0.46–0.80). The airway obstruction group also had a significantly higher risk of adverse events (28% vs. 16%; unadjusted OR, 1.93; 95% CI, 1.48–2.56, adjusted OR, 1.70; 95% CI, 1.27–2.29). In the sensitivity analysis using multiple imputation, the results remained consistent with the main results: the airway obstruction group had a significantly lower first-pass success rate (adjusted OR, 0.60; 95% CI, 0.48–0.76).ConclusionBased on these multicenter prospective data, airway obstruction was associated with a significantly lower first-pass success rate and a higher intubation-related adverse event rate in the ED.https://www.frontiersin.org/articles/10.3389/fmed.2023.1199750/fullairway obstructionfirst-pass successintubation-related adverse eventsemergency departmentadults |
| spellingShingle | Jin Takahashi Jin Takahashi Tadahiro Goto Shigeki Fujitani Hiroshi Okamoto Yusuke Hagiwara Hiroko Watase Kohei Hasegawa the Japanese Emergency Medicine Network Investigators Association of airway obstruction with first-pass success and intubation-related adverse events in the emergency department: multicenter prospective observational studies Frontiers in Medicine airway obstruction first-pass success intubation-related adverse events emergency department adults |
| title | Association of airway obstruction with first-pass success and intubation-related adverse events in the emergency department: multicenter prospective observational studies |
| title_full | Association of airway obstruction with first-pass success and intubation-related adverse events in the emergency department: multicenter prospective observational studies |
| title_fullStr | Association of airway obstruction with first-pass success and intubation-related adverse events in the emergency department: multicenter prospective observational studies |
| title_full_unstemmed | Association of airway obstruction with first-pass success and intubation-related adverse events in the emergency department: multicenter prospective observational studies |
| title_short | Association of airway obstruction with first-pass success and intubation-related adverse events in the emergency department: multicenter prospective observational studies |
| title_sort | association of airway obstruction with first pass success and intubation related adverse events in the emergency department multicenter prospective observational studies |
| topic | airway obstruction first-pass success intubation-related adverse events emergency department adults |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1199750/full |
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