Association Between Difficult Airway Predictors and Failed Prehosptial Endotracheal Intubation.

Abstract

OBJECTIVE:

Difficult airway predictors (DAPs) are associated with failure of endotracheal intubation (ETI) in the emergency department (ED). The purpose of this study was to determine if DAPs are associated with failure of prehospital ETI.

METHODS:

This retrospective study compared the prevalence of DAPs in cases of failed prehospital ETI successfully intubated in the ED (FPH/SED) with cases with no prehospital attempt that were successfully intubated in the ED on the first attempt by a physician using direct laryngoscopy (NPH/SED). All cases were transported by ground or air to an academic, level-1 trauma center.

RESULTS:

A total of 1377 ED ETIs were performed; 161 FPH/SED and 530 NPH/SED were identified. The odds ratios with 95% confidence intervals (CIs) of finding DAPs in the FPH/SED group compared with the NPH/SED group was blood = 5.80 (95% CI, 3.89-8.63), vomit = 2.01 (95% CI, 1.25-3.21), short neck = 2.67 (95% CI, 1.39-5.03), neck immobility = 2.52 (95% CI, 1.72-3.67), airway edema = 10.52 (95% CI, 4.15-29.92), facial trauma = 4.64 (95% CI, 2.91-7.39), and large tongue = 3.08 (95% CI, 1.75-5.40). When grouped by the number of DAPs per case (0, 1, 2, 3, or ≥ 4), the odds of multiple DAPs in cases of FPH/SED compared with NPH/SED ranged from 2.89 (95% CI, 1.71-4.90) with 1 DAP to 24.55 (95% CI, 10.60-56.90) with ≥ 4 DAPs.

CONCLUSION:

Cases of FPH/SED have more DAPs than NPH/SEDs.

• Authors: Joshua B Gaither, Uwe Stolz, Joshua Ennis, Jarrod Moiser, John C Sakles
• Journal: Air medical journal (Air Med J) 2015 Nov-Dec Vol. 34 Issue 6 Pg. 343-7 ISSN: 1532-6497 [Electronic] United States
• PMID: 26611221 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Emergency Medical Services
• Emergency Service, Hospital
• Facial Injuries (epidemiology)
• Female
• Hospitals, University
• Humans
• Immobilization (statistics & numerical data)
• Intubation, Intratracheal (statistics & numerical data)
• Laryngoscopy
• Male
• Middle Aged
• Neck (anatomy & histology)
• Odds Ratio
• Organ Size
• Retrospective Studies
• Risk Factors
• Tongue (anatomy & histology)
• Trauma Centers
• Treatment Failure
• Vomiting (epidemiology)
• Young Adult