14th Field Hospital, Fort Stewart, GA, Georgia; Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America.
University of Colorado School of Medicine, Aurora, CO, United States of America.
Am J Emerg Med. 2024 Nov;85:202-207. doi: 10.1016/j.ajem.2024.09.014. Epub 2024 Sep 11.
Peri-intubation complications are important sequelae of airway management in the emergency department (ED). Our objective was to quantify the increased risk of complications with multiple attempts at emergency airway intubation in the ED.
This is a secondary analysis of a prospectively collected multicenter registry (National Emergency Airway Registry) consisting of attempted ED intubations among subjects aged >14 years. The primary exposure variable was the number of intubation attempts. The primary outcome measure was the occurrence of peri-intubation major complications within 15 min of intubation including hypotension, hypoxemia, vomiting, dysrhythmias, cardiac arrest, esophageal intubation, and failed airway with cricothyrotomy. We constructed multivariable logistic regression models to determine the associations between complications and the number of intubation attempts while controlling for measured pre-exposure variables.
There were 19,071 intubations in the NEAR database, of which 15,079 met inclusion for this analysis. Of these, 13,459 were successfully intubated on the first attempt, 1,268 on the second attempt, 269 on the third attempt, 61 on the fourth attempt, and 22 on the fifth or more attempt. A complication occurred in 2,137 encounters (14 %). Major complications accompanied 1,968 encounters (13 %) whereas minor complications affected 315 encounters (2 %). The most common major complication was hypoxia. In our multivariable logistic regression model, odds ratios with 95 % confidence intervals for the occurrence of major complications for multiple attempts compared to first-pass success were 4.4 (3.6-5.3), 7.4 (5.0-10.7), 13.9 (5.6-34.3), and 9.3 (2.1-41.7) for attempts 2-5+ (reference attempt 1), respectively.
We found an independent association between the number of intubation attempts among ED patients undergoing emergency airway intubation and the risk of complications.
围插管期并发症是急诊科（ED）气道管理的重要后遗症。我们的目的是量化 ED 多次尝试紧急气道插管时并发症的风险增加。
这是一项对前瞻性收集的多中心登记处（国家紧急气道登记处）进行的二次分析，该登记处包括对年龄> 14 岁的受试者进行的 ED 插管尝试。主要暴露变量是插管尝试次数。主要结局指标是插管后 15 分钟内发生的围插管期主要并发症，包括低血压、低氧血症、呕吐、心律失常、心脏骤停、食管插管和环甲膜切开术失败的气道。我们构建了多变量逻辑回归模型，以确定并发症与插管尝试次数之间的关联，同时控制了暴露前的测量变量。
NEAR 数据库中有 19071 次插管，其中 15079 次符合本分析的纳入标准。其中，13459 次在第一次尝试时成功插管，1268 次在第二次尝试时，269 次在第三次尝试时，61 次在第四次尝试时，22 次在第五次或更多次尝试时。有 2137 次（14%）发生并发症。主要并发症伴随 1968 次（13%），而轻微并发症影响 315 次（2%）。最常见的主要并发症是缺氧。在我们的多变量逻辑回归模型中，与首次尝试成功相比，多次尝试发生主要并发症的优势比（95%置信区间）分别为 4.4（3.6-5.3）、7.4（5.0-10.7）、13.9（5.6-34.3）和 9.3（2.1-41.7）尝试 2-5+（参考尝试 1）。
我们发现 ED 患者行紧急气道插管时，插管次数与并发症风险之间存在独立关联。
