“Systematic review and meta-analysis of first pass success rates in emergency department intubation: Creating a benchmark for emergency care.”
Park, L., Zeng, I. and Brainard, A. Emergency Medicine Australasia.
Objective: to identify an expected first pass success rate and complication rates
Methods: review and meta-analysis of prospective studies of ED intubations. Excluded retrospective chart reviews or studies looking at subpopulations, ex pediatric, or were limited to one airway device, ex video only.
16 studies were included reporting a total of ~42,000 intubations in 83 EDs and 10 countries. Centers were mostly academic and 11 of the 16 studies were from the last 10 years. Subdivided into a ‘Trauma-Only’ group only in the US comprising 1708 intubations.
Results:
First pass success rates:
‘All ED’ intubations: 84.1%
‘Trauma-Only’ intubations: 81.8%
Significant Adverse Events
Hypoxia: 6.4%
Hypotension: 3.0%
Esophageal intubation: 3.5%
Cricothyroidotomy: 0.3%
Discussion:
The aim of this study was to identify the most realistic benchmark for first pass success and rates if the most frequent complications. The study looks at ‘all comer’ intubations with a very large pool of intubations. Specific studies have a large range of FPS, from the 70’s to the 90’s, and comparable ranges of complications. The discussion mentions most studies were at academic institutions implying resident involvement but the details aren’t readily available. Other studies I’ve seen demonstrate usually around a 10% FPS difference from interns to graduating residents, however this is unknown in this review. Other details including medications used, direct vs indirect, skill level of operator, number of attempts may all seem relevant as well. In their discussion, they would like to suggest that bypassing these details gives the ‘real world’ numbers, given any situation or setting.
How does this change practice? Mostly it doesn’t. These numbers are meant to be a reference for your personal practice and your institution. Are you hitting similar numbers or does every patient seem to end up cric’d? I find studies like this interesting in a ‘store in the back of your head’ kind of way and not necessarily meant to change practice.
Systematic review and meta-analysis of first pass success rates in emergency department intubation: Creating a benchmark for emergency care. Park, L., Zeng, I. and Brainard, A. Emergency Medicine Australasia
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