Factors associated with successful rescue intubation attempts in the emergency department: an analysis of multicenter prospective observational study in Japan

Aim It remains unclear whether physicians should change intubation approaches after the failed first attempt. We aimed to determine the rescue intervention approaches associated with a higher success rate at the second attempt in the emergency department ( ED ). Methods We analyzed the data from a prospective, multicenter, observational study – the second Japanese Emergency Airway Network Study. The current analysis included all patients who underwent emergency intubation from February 2012 through November 2017. We defined a rescue intubation attempt as a second intubation attempt with any change in intubation approaches (i.e., change in methods, devices, or intubators) from the failed first attempt. The outcome measure was second‐attempt success. Results Of 2,710 patients with a failed first attempt, 43% underwent a second intubation attempt with changes in intubation approach (i.e., rescue intubation). Rescue intubation attempts were associated with a higher second‐attempt success rate compared to non‐rescue intubation attempts (adjusted odds ratio [ OR ], 1.78; 95% confidence interval [ CI ], 1.50–2.12). The rescue intubation approaches associated with a higher second‐attempt success were changes from non‐rapid sequence intubation ( RSI ) to RSI (adjusted OR , 2.04; 95% CI , 1.12–3.75), from non‐emergency medicine ( EM ) residents to EM residents (adjusted OR , 2.02; 95% CI , 1.44–2.82), and from non‐ EM attending physicians to EM attending physicians (adjusted OR , 2.82; 95% CI , 2.14–3.71). Conclusions In this large multicenter study, rescue interventions were associated with a higher second‐attempt success rate. The data also support the use of RSI and backup by EM residents or EM attending physicians to improve the airway management performance after a failed attempt in the ED .