Complications increase with greater than one endotracheal intubation attempt: experience in a Canadian adult tertiary-care teaching center

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Introduction

A prospective review was undertaken to better understand out-of-operating room endotracheal intubation (ETI) procedures performed throughout a 402-bed Canadian adult tertiary-care teaching center.

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Methods

The circumstances, methods and complications of ETI were collected over an 11-month period (July 2012 - May 2013). Respiratory therapists documented information throughout ETI using data-recording cards. To estimate data-capture rate, data cards were compared with hospital records of all admitted, ventilated patients during this time.

Results

Data regarding 271 patients undergoing ETI was obtained, accounting for 70% of patients admitted to hospital who required mechanical ventilation. However, this may not accurately reflect our data-capture rate; not all admitted and ventilated patients underwent ETI at our center, and some patients captured on our data-cards either died or were extubated in the emergency department prior to admission. One hundred eighty-two patients required one attempt, 89 required more than one attempt. One

Conclusions

Greater than one attempt at ETI was associated with a 4-fold increase in severe, and a 5-fold increase in total complications. Although previous publications found greater than 2 attempts associated with increased complications [1], [2], recent publications found a similar association with greater than one attempt [3], [4], consistent with our findings. This new information has implications for both teaching and decision-making of ETI.

Disclosures

None. This work is without financial support and performed as part of a broader quality improvement initiative through the multi-disciplinary Royal Columbian Hospital Airway Committee, New Westminster, British Columbia, Canada.

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