The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Stacey J. Milligan1, Carl R. Hinkson1, Arman H. Dagal2, Yulia Ivashkov2, Sam R. Sharar2, Aaron M. Joffee2; 1Respiratory Care, Harborview Medical Center, Seattle, WA; 2Department of Anesthesiology and Pain Medicine, Harborview Medical Center, Seattle, WA

Introduction: Emergency endotracheal intubation (ETI) is a potentially life-saving procedure frequently performed outside of the operating room (OR). Compared to elective surgical patients, difficult intubation (DI), hypoxemia, and hemodynamic instability occur more often in the outside the OR setting. Our primary goal was to describe the experience of a large academic medical center with out of OR intubations with particular attention to the occurrence of airway related complications, including DI. Methods: Medical records were retrospectively reviewed (July 2008 – June 2011) for ETIs performed outside the OR at Harborview Medical Center, a university-affiliated 413-bed municipal medical center and regional Level 1 trauma center in Seattle, WA. Pediatrics or records with incomplete data were excluded. DI was defined as: > 3 attempts at direct laryngoscopy (DL), > 2 attempts at DL with Eschmann use, any DL needing rescue by other means, > 1 attempts at videolaryngoscopy (VL) with Eschmann use, > 2 attempts at VL, any need for a flexible fiberoptic bronchoscope (FOB), any need for a surgical airway, or the occurrence of any ETI-related complication (systolic blood pressure < 90 mmHg, hypotension requiring treatment, heart rate < 60, oxygen saturation < 90%, or aspiration). Data are presented as number of patients (%) unless otherwise indicated. Results: A total of 2,499 intubations were included. Data regarding location, intubating service, patient type, and indication for intubation are presented in table 1. Intubation was accomplished by DL alone in 2,168 (87) cases and with the aid of an Eschmann in another 59 (2). Rescue by VL was needed in 12 (0.5) cases. VL alone was successful in 241 (10) cases and required the aid of an Eschmann in another 12 (0.5). FOB was only used in 2 (0.08) cases as the initial airway management technique, but was used as a VL rescue 6 (0.24) times. 5 patients (0.2%) required surgical airways. Overall, the incidence of difficult airways was 6% (n=166) of which 107 (64.5%) were difficult intubations and 59 (35.5) easy, but having encountered airway related complications. Conclusions: In a setting of multiple specialists performing oustide the OR intubations in a large urban academic medical center, incidence of DI due to airway management or intubation-related complications is low. While DL remains the most common initial airway management technique of choice, FOB appears to have been largely replaced by VL. Sponsored Research - None