Emergency airway management in a Singapore centre: A registry study.
10.47102/annals-acadmedsg.2020331
- Author:
Gene Wai Han CHAN
1
;
Chew Yian CHAI
;
Joy Su-Yue TEO
;
Calvin Kai En TJIO
;
Mui Teng CHUA
;
Calvin A BROWN III
Author Information
1. Emergency Medicine Department, National University Hospital, National University Health System, Singapore.
- Publication Type:Journal Article
- From:Annals of the Academy of Medicine, Singapore
2021;50(1):42-51
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Intubations in the emergency department (ED) are often performed immediately without the benefit of pre-selection or the ability to defer. Multicentre observational data provide a framework for understanding emergency airway management but regional practice variation may exist. We aim to describe the intubation indications, prevalence of difficult airway features, peri-intubation adverse events and intubator characteristics in the ED of the National University Hospital, Singapore.
METHODS:We conducted a prospective observational study over a period of 31 months from 1 March 2016 to 28 September 2018. Information regarding each intubation attempt, such as indications for intubation, airway assessment, intubation techniques used, peri-intubation adverse events, and clinical outcomes, was collected and described.
RESULTS:There were 669 patients, with male predominance (67.3%, 450/669) and mean age of 60.9 years (standard deviation [SD] 18.1). Of these, 25.6% were obese or grossly obese and majority were intubated due to medical indications (84.8%, 567/669). Emergency physicians' initial impression of difficult airway correlated with a higher grade of glottis view on laryngoscopy. First-pass intubation success rate was 86.5%, with hypoxia (11.2%, 75/669) and hypotension (3.7%, 25/669) reported as the two most common adverse events. Majority was rapid sequence intubation (67.3%, 450/669) and the device used was most frequently a video laryngoscope (75.6%, 506/669). More than half of the intubations were performed by postgraduate clinicians in year 5 and above, clinical fellows or attending physicians.
CONCLUSION:In our centre, the majority of emergency intubations were performed for medical indications by senior doctors utilising rapid sequence intubation and video laryngoscopy with good ffirst-attempt success.
