Airway management practices among emergency physicians: An observational study
Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
Keywords: Airway management, emergency physicians, intubation, observational study
OBJECTIVES: Emergency airway management is an integral part of patient stabilization. It is an essential skill for an emergency physician to master. There is a paucity of literature on airway management from low-to-middle-income countries like India where emergency medicine (EM) specialty is still in its infancy. We conducted this study to identify the existing airway management practices among emergency physicians in our tertiary care center. This study could pave the way for national airway registries.
METHODS: This prospective, observational study was conducted in the emergency department (ED) of a tertiary care center in India for 16 months. We included 166 patients who underwent emergency endotracheal intubation in the ED, irrespective of their age or underlying condition. The patients were observed for 15 min after intubation to identify any associated adverse events. We collected data about patients’ demographic profile, indication for intubation, techniques of airway management, medications used, specialty of the physician performing intubation, use of preintubation and postintubation checklists, vitals before and after intubation, and any adverse events following intubation.
RESULTS: A total of 166 patients who required definite airway management in the ED were recruited for the study. The mean age of patients was 45.5 ± 20.1 years. Males comprised 61.4% of the patients. One hundred and forty-four patients were nontrauma cases and the remaining 22 cases were related to trauma. The most common indication for emergency airway management was altered mental status among nontrauma encounters and traumatic brain injury among trauma patients. Rapid sequence intubation (RSI) was the most common method employed (72.9% of cases). The most common agents used for induction and paralysis were etomidate and rocuronium, respectively. Direct laryngoscope was used in about 95% of cases. The first pass success rate in our study was 78.3%. EM residents were able to perform orotracheal intubation for all patients and none required a surgical airway. The incidence of adverse events within 15 min of intubation was 58.4%. Common complications observed were desaturation, right mainstem bronchus intubation, and equipment failure. Postintubation cardiac arrest occurred in around 5% of cases.
CONCLUSION: RSI remains the most common method employed for emergency airway management. There exists heterogeneity in the practice and its associated complications. Hence, regular surveillance, quality improvement, and training are imperative to provide good patient care.
How to cite this article: Jishnu M, Bhoi S, Sahu AK, Suresh S, Aggarwal P. Airway management practices among emergency physicians: An observational study. Turk J Emerg Med 2022;22:186-91.
This study protocol has been approved from ethical angle by Institute Ethics Committee, AIIMS, New Delhi w.e.f.28.06.2018 (IECPG-266/28.06.2018).
Written consent was obtained from the next of kin.
SB and PA conceived the study. JM and SS undertook the recruitment of participants and data collection. AKS provided statistical advise and analyzed the data. JM and SS drafted the manuscript and all authors contributed substantially to its revision. SB chaired the data oversight committee and takes responsibility for the paper as a whole.