Abstract

Background & Aims: Emergency endotracheal intubation is a life-saving procedure in any setting. We compared the outcomes of emergency endotracheal intubation calls for Anesthesiologists in General ward, Critical care unit and Triage in a single medical centre.

Settings and Design: Prospective, Cross sectional study.

Methods and Material: We evaluated all patients admitted to the Ward, Critical care unit and Triage between October 2021 to November 2022. A total of 186 patients, >18 years of age, who required emergency endotracheal intubation were included in this study. Primary outcome was to estimate the proportion of difficult & failed endotracheal in tubation. Secondary outcome was to assess the incidence of complications, survival and neurological outcome.

Results: General ward had the highest proportion of difficult intubations (67.74%), followed by Triage (62.9%), and CCU (61.29%). General ward had 4.83% failed intubation followed by Triage 1.61%. The incidence of hypoxemia (33.87%) and hemodynamic collapse (12.9%) was higher in General ward as compared to CCU (12.9% & 9.68%) and Triage (24.19% &11.2%), (P=0.02 & 0.04 respectively). There was a trend of higher survival rate in CCU (67.74%) as compared to General ward (25.61%) & Triage (51.61%). Among these locations, CCU had the highest rate of neurologically intact (53.23%) survival to hospital discharge as compared to General ward (16.13%) & Triage (30.63%). Conclusions: We concluded that the proportion of difficult and failed intubation, was highest in General ward followed by Triage and CCU. Incidence of complications was least in CCU followed by Triage and General ward.

• 1.   Taboada M, Doldan P, Calvo A, Almeida X, Ferreiroa E, Baluja A, et al. Comparison of tracheal intubation conditions in operating room and intensive care unit: a Prospective, Observational Study. Anesthesiology. 2018;129(1):32-8.
• 2.   Jaber S, Amraoui J, Lefrant JY, Arich C, Cohendy R, Landreau L. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med. 2006;34(9):2355-61.
• 3.   Hsiao YJ, Chen CY. Comparison of the outcome of emergency endotracheal intubation in the general ward, intensive care unit and emergency department. Crit Care Med. 2020;56(5 Suppl 1):2319-4170. (Note: The page format
• 4.   Brian E, Mathew E. Effect of use of bougie vs endotracheal tube and stylet on first attempt intubation success among patients with difficult airway undergoing emergency intubation. JAMA. 2018;319(21):2179-89.
• 5.   Martin LD, Mhyre JM. 3,423 Emergency tracheal intubations at a university hospital: airway outcomes and complications. Anesthesiology. 2011;114(1):42-8.
• 6.   Schwartz DE, Matthay MA, Cohen NH. Death and other complications of emergency airway management in critically ill adults: a prospective investigation of 297 tracheal intubations. Anesthesiology. 1995;82(2):367-76.
• 7.   Mort TC. Complications of emergency tracheal intubation: Immediate airway related consequences: part II. J Intensive Care Med. 2007;22(4):208-15.
• 8.   Ulrich H. Effects of Supervision by Attending Anesthesiologists on Complications of Emergency Tracheal Intubation. Anesthesiology. 2008;109(6):973–7.
• 9.   Arul kumaran N, McLaren CS. An analysis of emergency tracheal intubations in critically ill patients by critical care trainees. Intensive Care Soc. 2018;19(3):180-7. (Note: Assuming the journal name is related to the society, often abbreviated.)
• 10.   De Jong A, Molinari N. Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units. Br J Anaesth. 2015;114(2):297-306.
• 11.   Wong E, Ng YY. The difficult airway in the emergency department. Int J Emerg Med. 2008;1(3):107–11.
• 12.   Charlson ME. Charlson Comorbidity Index: A Critical Review of Clinimetric Properties. Anesthesiology. 2022;91(1):8–35. (Note: The year 2022 and volume 91 appear inconsistent for a journal like Anesthesiology, but the reference is formatted as provided.)

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Funding