Emergency airway management by resident physicians in J apan: an analysis of multicentre prospective observational study

Aim To examine the success rates of emergency department airway management by resident physicians in J apan. Methods We conducted an analysis of a multicentre prospective registry ( J apanese E mergency A irway N etwork R egistry) of 13 academic and community emergency departments in J apan. We included all patients who underwent emergency intubation performed by postgraduate year 1 to 5 transitional or emergency medicine residents (resident physicians) between A pril 2010 and A ugust 2012. Outcome measures were success rates by the first intubator, and by rescue intubator, according to the level of training. Results We recorded 4,094 intubations (capture rate, 96%); 2,800 attempts (2,800/4,094; 68%; 95% confidence interval ( CI ), 67%–70%) were initially performed by resident physicians. Overall success rate on the first attempt was 63% (1,767/2,789; 95% CI , 61%–64%); the rate improved over the first 3 years of training before reaching a plateau ( P trend  < 0.001). Success rate by the first intubator was 78% (2,185/2,800; 95% CI , 76%–79%); the rate steadily improved as level of training increased ( P trend  < 0.001). Of 597 failed intubation attempts by the first intubator, 41% (247/597; 95% CI , 37%–45%) of rescue attempts were performed by resident physicians. Success rate on the first rescue attempt was 76% (187/247; 95% CI , 70%–81%), and success rate by first rescue intubator was 89% (220/247; 95% CI , 85%–93%). These rates on rescue attempts steadily improved as level of training increased (both P trend  < 0.001). Intubations were ultimately successful in 2,778 encounters (99.6%). Conclusion In this multicentre study characterizing emergency airway management across J apan, we observed that emergency department intubations were primarily managed by resident physicians with acceptably high success rates overall.