Emergency Medicine Sat 09 January 2021 Clinical profile of patients requiring emergency airway management in the department of emergency medicine
Researcher : Jishnu mohan
Research Guide : Sanjeev bhoi
Institution Name : Aiims new delhi


Background and aim: Successful airway management is a cornerstone in practice of emergency and trauma care. The main purpose of this research was to study clinical profile of patients requiring emergency airway management in the department of emergency medicine. And also, to describe intubation indications, method used, drugs used, associated events, operator characteristics. Similar studies have been conducted in other countries. But no such study has been performed in Emergency department in India. So, this study may help in filling the lacunae in the existing knowledge and to suggest change ideas for improvement of emergency airway management. Patients and method: This was a prospective observational study with sample size of 166 patients who presented to Emergency Department and underwent emergency endotracheal intubation. We also enrolled all age group patients. Data were collected based on a standardized data form, which in turn was based on emergency airway management events. Data collection extended during a period from July 2018 to August 2020.Cases were followed up to 15 minutes post intubation. Results: Total of 166 cases were recruited for the study, out of which 75.3% of cases were in the age group 18-65 years. Males were more than females with a sex ratio of 1.6:1. Out of 144 cases of medical encounters most common indication for definite airway was altered mental status which constituted 52(36.1%) cases. Most common trauma encounter was head injury 15(68.2%). 13(7.8%) cases were predicted to be difficult airway. Most common method used for intubation was rapid sequence intubation (RSI) in 121(72.9%). Most used sedative agent for induction was Etomidate 78(47%). Rocuronium was the most used paralytic agent in 107(64.5%). Over all 100 % of cases achieved a successful airway with less than 3 attempts, with an FPS of 78.3%. Equipment failure had been found to be associated with first pass failure(p=0.04).The first pass success in difficult airway was 77%.Senior residents did most of the difficult airway intubation 7(53.9%) compared to PGY1,PGY2,PGY3(p=0.04).Major intubation associated events noted postintubation were desaturation 22(13.3%),right mainstem intubation in 20(12%), equipment failure in 14(8.4%),bradycardia11(6.6%),hypotension 10(6%),peri-intubation cardiac arrest 9(5.4%), and esophageal intubation 4(2.4%).As the number of attempts increased incidence of post intubation associated events also increased in the case of desaturation(p=0.00),hypotension(0.03), esophageal intubation(p=0.03) and post intubation cardiac arrest(p=0.04). Post intubation cardiac arrest is related to patient’s pre-intubation increased respiratory rate (p=0.02) and number of attempts (p=0.04). Resident designation did not play a role in PICA (p=0.38). Conclusion: In our study, we found that most ED intubations were performed for medical indications, most commonly for altered mental status of GCS Score≤ 9. Emergency physicians perform vast majority of intubation by RSI. Despite the presumably critical illness of all patients in the study and unexpected nature of intubation procedure, we have achieved an overall success rate of 100 %, with first pass success rate of 78.3%. Training in emergency medicine residency programs can improve further the first pass success. We have provided fundamental descriptive data, which can be served as a reference for future studies for evaluation of performance in ED in the Indian setting. We propose formation of an emergency airway registry in India, which will help filling some gaps in the existing knowledge and also facilitate future research

DOI: 1610213280   Year of publication: 2021

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