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