Study objective

We sought to (1) characterize emergency department (ED) intubations in trauma patients and estimate (2) first-pass success and (3) the association between patient and intubation characteristics and first-pass success.

Methods

We performed a secondary analysis of a multicenter prospective observational cohort of ED intubations from the National Emergency Airway Registry (NEAR). Descriptive statistics were calculated for all patients who were intubated for trauma at 23 NEAR EDs between 2016 and 2018. We evaluated first-pass success in patients intubated by (1) emergency or pediatric emergency physicians, (2) using rapid sequence intubation or no medications, and (3) either direct laryngoscopy or video laryngoscopy. We used propensity score matching with a generalized linear mixed-effects model to estimate the associations between patient and intubation characteristics and first-pass success.

Results

Of the 19,071 intubations in NEAR, 4,449 (23%) were for trauma, and nearly all (88%) had at least one difficult airway characteristic. Prevalence of first-pass success was 86.8% (95% confidence interval [CI]: 83.3% to 90.3%). Most patients were intubated with video laryngoscopy, and patients were more likely to be intubated on first-pass with video laryngoscopy as compared to direct laryngoscopy (90% versus 79%). After propensity score matching, video laryngoscopy remained associated with first-pass success (adjusted risk difference 11%, 95% CI: 8% to 14%; and OR 2.2, 95% CI: 1.6 to 2.9). Additionally, an initial impression of difficult airway, blood/vomit in the airway, and use of external laryngeal manipulation were all associated with decreased odds of first-pass success.

Conclusion

Emergency physicians are successful at intubating patients in the setting of trauma, and video laryngoscopy is associated with twice the odds of first-pass success when compared to direct laryngoscopy.

中文翻译：

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视频喉镜检查与创伤患者急诊室插管的首次成功相关：国家急诊气道登记处的倾向评分匹配分析

学习目标

我们试图 (1) 描述外伤患者急诊科 (ED) 插管的特征，并估计 (2) 首过成功率和 (3) 患者和插管特征与首过成功率之间的关联。

方法

我们对来自国家紧急气道登记处 (NEAR) 的 ED 插管多中心前瞻性观察队列进行了二次分析。对 2016 年至 2018 年间在 23 次 NEAR ED 中因外伤插管的所有患者进行了描述性统计。我们评估了由 (1) 急诊或儿科急诊医生、(2) 使用快速序列插管或无药物插管的患者的首过成功率，和 (3) 直接喉镜检查或视频喉镜检查。我们使用倾向评分与广义线性混合效应模型相匹配来估计患者和插管特征与首次通过成功之间的关联。

结果

在 NEAR 的 19,071 次插管中，4,449 次 (23%) 是外伤，几乎所有 (88%) 都至少有一个困难气道特征。首过成功率为 86.8%（95% 置信区间 [CI]：83.3% 至 90.3%）。大多数患者使用视频喉镜进行插管，与直接喉镜检查相比，患者更有可能在首次使用视频喉镜检查时进行插管（90% 对 79%）。倾向评分匹配后，视频喉镜检查仍与首次通过成功相关（调整后风险差异 11%，95% CI：8% 至 14%；OR 2.2，95% CI：1.6 至 2.9）。此外，对困难气道的初步印象、气道中的血液/呕吐物以及喉外操作的使用都与首过成功率降低有关。

结论

急诊医生在创伤情况下成功地为患者插管，与直接喉镜检查相比，视频喉镜检查的首过成功几率是其两倍。