Endotracheal Intubations in Emergency Department: A Clinical Audit at a Tertiary Health Centre in South India
AJTES Vol. 5, No 2, July 2021.
Full text

Keywords

Critical airway management
Residency training
Academic emergency department
Emergency physician
anesthetist

How to Cite

SM, L., Sivam, R., Paul, N., George, M., & Babu, S. (2021). Endotracheal Intubations in Emergency Department: A Clinical Audit at a Tertiary Health Centre in South India. Albanian Journal of Trauma and Emergency Surgery, 5(2), 842-848. https://doi.org/10.32391/ajtes.v5i2.238

Abstract

Background: Endotracheal intubation in the emergency department is challenging. Hence, regular audits can help us improve our critical airway management skills. Our study aimed to evaluate the practice of endotracheal intubations performed in the emergency department.

Materials and Methods: A retrospective cross-sectional study was conducted among the patients intubated in our teaching hospital's emergency department. The study period was from November 1, 2019, to August 31, 2020. We analyzed first attempt success rates, drug use, indication, and complications.

Results: We analysed 90 endotracheal intubations, out of which 70(77.8%) were performed by emergency physicians and 20(22.2%) by anaesthetists. The first attempt success rate was 81.11% (n=73) and had significant differences between the both departments. (p value= 0.003,  χ2= 7.48). More patients had medical indications compared to trauma for intubation (n=88 vs n=32) among which respiratory failure (n=25, 27.78%) was the most common indication. Rapid Sequence Intubation( RSI) adherence was 82.22% (n=74). Lignocaine (n=16, 19.75%), etomidate (n=35, 43.2%) and succinylcholine (n=65, 80.25%) were the commonly used drugs for premedication, induction and as relaxants respectively. 17(18.89%) out of 90 intubation had complications. Desaturation (n=10, 11.11%), bradycardia (n=1, 1.11%), hypotension (n=4, 44%), dental trauma (n=5, 5.55%) and oesophageal intubation (n=3, 3.33%) were observed in our study.

Conclusion: Our study is the first  from India which describes the characteristics of endotracheal intubations done in the Emergency Department along with data on RSI adherence. The first attempt success rate, indications, and complications were comparable with other studies in the literature. We recommend future prospective studies to analyze success rates between different specialties and resident doctors to improve the airway management skills in the Department

https://doi.org/10.32391/ajtes.v5i2.238
Full text

References

Stevenson A.G.M., Graham CA, Hall R, Korsah P, McGuffie AC. Tracheal intubation in the emergency department: The Scottish district hospital perspective. Emerg Med J. 2007;24(6):394–7. DOI: 10.1136/emj.2006.041988.

Ono Y, Kakamu T, Kikuchi H, Mori Y, Watanabe Y, Shinohara K. Expert-Performed Endotracheal Intubation-Related Complications in Trauma Patients: Incidence, Possible Risk Factors, and Outcomes in the Prehospital Setting and Emergency Department. Emerg Med Int. 2018;2018:1–9. DOI: 10.1155/2018/5649476.

Medical Council of India (MCI). Medical Council of India Notification. New Delhi: The Gazette of India: Extraordinary; 2009 p. 12.

Adams M, Bandara L. Airway management in the emergency department. Br J Anaesth. 2002;88(6). DOI: 10.1093/BJA/88.1.9

Wright KD, Cadamy AJ, White M, Walker A, Brenchley J. Survey of the use of rapid sequence induction in the accident and emergency department (multiple letters). Emerg Med J. 2001;18(3):232–3. DOI: 10.1136/emj.17.2.95

Fathil SM, Mahdi S.N.M., Che'Man Z, Hassan A, Ahmad Z, Ismail AK. A prospective study of tracheal intubation in an academic emergency department in Malaysia. Int J Emerg Med. 2010;3(4):233–7.

Dr. Pradip Jadav Study of Endotracheal Intubation in Emergency Room of a Tertiary Care Hospital of Ahmedabad City of Gujarat, India International Journal of Scientific Research, Vol.II, Issue.XII December 2013. DOI: 10.1007/s12245-010-0201-0

Fogg T, Annesley N, Hitos K, Vassiliadis J. Prospective observational study of the practice of endotracheal intubation in the emergency department of a tertiary hospital in Sydney, Australia. Emerg Med Australas. 2012 Dec;24(6):617-24. DOI: 10.1111/1742-6723.12005.

Reed MJ, Dunn MJ, McKeown DW. Can an airway assessment score predict difficulty at intubation in the emergency department? Emerg Med J. 2005 Feb;22(2):99-102. DOI: 10.1136/emj.2003.008771.

Krage R, van Rijn C, van Groeningen D, Loer SA, Schwarte LA, Schober P. Cormack-Lehane classification revisited. Br J Anaesth. 2010 Aug;105(2):220-7. DOI: 10.1093/BJA/aeq136. Epub 2010 June 16.

Hockberger, R, Gausche-hill, M. Rosen's Emergency Medicine: Concepts and Clinical Practice. (9th ed.). United States: Elsevier; 2017.

Fogg T, Alkhouri H, Vassiliadis J. The Royal North Shore Hospital Emergency Department airway registry: Closing the audit loop. Emerg Med Australas. 2016 Feb;28(1):27-33. DOI: 10.1111/1742-6723.12496. Epub 2015 November 11. DOI: 10.1111/1742-6723.12496.

Walls RM, Brown CA 3rd, Bair AE, Pallin DJ; NEAR II Investigators. Emergency airway management: a multi-center report of 8937 emergency department intubations. J Emerg Med. 2011 Oct;41(4):347-54. DOI: 10.1016/j.jemermed.2010.02.024.

Kerslake D, Oglesby AJ, Di Rollo N, James E, McKeown DW, Ray DC; EDIR investigators. Tracheal intubation in an urban emergency department in Scotland: a prospective, observational study of 3738 intubations. Resuscitation. 2015 Apr;89:20-4. DOI: 10.1016/j.resuscitation.2015.01.005.

Fadhlillah F, Bury S, Grocholski E, Dean M, Refson A. Emergency Airway Management: A Look into the Practice, Rate of Success, and Adverse Events of 94 Endotracheal Intubations. J Emerg Trauma Shock. 2020 Jan-Mar;13(1):58-61. DOI: 10.4103/JETS.JETS_100_19

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.