Impact of a Critical Care Specialist Intervention on First Pass Success for Emergency Airway Management Outside the ICU

Daniel G. Fein, Fiore Mastroianni, Charles G. Murphy, Michael Aboodi, Ryan Malik, Nader Emami, Matthew Abramowitz, Ariel L. Shiloh, Lewis Eisen

Research output: Contribution to journalArticle

Abstract

Background: There has been limited investigation into the procedural outcomes of patients undergoing emergent endotracheal intubation (EEI) by a critical care medicine (CCM) specialist outside the intensive care unit (ICU). We hypothesized that EEI outside an ICU would be associated with lower rates of first pass success (FPS) as compared to inside an ICU. Methods: We performed a retrospective cohort study of all adult patients admitted to our academic medical center between January 1, 2016, and July 31, 2018, who underwent EEI by a CCM practitioner. The primary outcome of FPS was identified in the EEI procedure note. Secondary outcomes included difficult intubation (> 2 attempts at laryngoscopy) and mortality following EEI. Results: In total, 1958 patients (1035 [52.9%] inside ICU and 923 [47.1%]) outside an ICU) were included in the final cohort. Unadjusted rate of FPS was not different between patients intubated out of the ICU and patients intubated inside of the ICU (689 [74.7%] vs 775 [74.9%]; P =.91). There was also no difference in FPS between groups after adjusting for predictors of difficult intubation and baseline covariates (odds ratio: 0.95; 95% confidence interval, 0.75-1.2, P =.65). Mortality of patients undergoing EEI out of the ICU was higher at each examined time interval following EEI. Discussion: For EEI done by CCM practitioners, rate of FPS is not different between patients undergoing EEI outside an ICU as compared to inside an ICU. Despite the lack of difference between rates of procedural success, patient mortality following EEI outside an ICU is higher than EEI inside an ICU at all examined time points during hospitalization.

Original languageEnglish (US)
JournalJournal of Intensive Care Medicine
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Airway Management
Intratracheal Intubation
Critical Care
Intensive Care Units
Emergencies
Medicine
Intubation
Mortality
Laryngoscopy
Hospitalization
Cohort Studies
Retrospective Studies
Odds Ratio

Keywords

  • critical care
  • endotracheal intubation
  • outcomes
  • respiratory failure

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Impact of a Critical Care Specialist Intervention on First Pass Success for Emergency Airway Management Outside the ICU. / Fein, Daniel G.; Mastroianni, Fiore; Murphy, Charles G.; Aboodi, Michael; Malik, Ryan; Emami, Nader; Abramowitz, Matthew; Shiloh, Ariel L.; Eisen, Lewis.

In: Journal of Intensive Care Medicine, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: There has been limited investigation into the procedural outcomes of patients undergoing emergent endotracheal intubation (EEI) by a critical care medicine (CCM) specialist outside the intensive care unit (ICU). We hypothesized that EEI outside an ICU would be associated with lower rates of first pass success (FPS) as compared to inside an ICU. Methods: We performed a retrospective cohort study of all adult patients admitted to our academic medical center between January 1, 2016, and July 31, 2018, who underwent EEI by a CCM practitioner. The primary outcome of FPS was identified in the EEI procedure note. Secondary outcomes included difficult intubation (> 2 attempts at laryngoscopy) and mortality following EEI. Results: In total, 1958 patients (1035 [52.9{\%}] inside ICU and 923 [47.1{\%}]) outside an ICU) were included in the final cohort. Unadjusted rate of FPS was not different between patients intubated out of the ICU and patients intubated inside of the ICU (689 [74.7{\%}] vs 775 [74.9{\%}]; P =.91). There was also no difference in FPS between groups after adjusting for predictors of difficult intubation and baseline covariates (odds ratio: 0.95; 95{\%} confidence interval, 0.75-1.2, P =.65). Mortality of patients undergoing EEI out of the ICU was higher at each examined time interval following EEI. Discussion: For EEI done by CCM practitioners, rate of FPS is not different between patients undergoing EEI outside an ICU as compared to inside an ICU. Despite the lack of difference between rates of procedural success, patient mortality following EEI outside an ICU is higher than EEI inside an ICU at all examined time points during hospitalization.",
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AU - Malik, Ryan

AU - Emami, Nader

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