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Emergency Department Adult Fiberoptic Intubations: Incidence, Indications, and Implications for Training
Author(s) -
Hayden Emily M.,
Pallin Daniel J.,
Wilcox Susan R.,
Gordon James A.,
Carlson Jestin N.,
Walls Ron M.,
Brown Calvin A.
Publication year - 2018
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13440
Subject(s) - medicine , emergency department , intubation , airway , confidence interval , incidence (geometry) , emergency medicine , airway obstruction , surgery , physics , psychiatry , optics
Abstract Objective The objective was to describe the frequency, indications, and outcomes of flexible fiberoptic intubations ( FFI ) performed in the emergency department ( ED ). Methods From the National Emergency Airway Registry ( NEAR ), we identified all encounters from July 1, 2002, through December 31, 2012, with the use of FFI . We determined patient, provider, and intubation characteristics; success and failure rates; and modes of intubation rescue. Results Among 17,910 intubations of patients > 15 years old at 13 ED s, FFI was used in 204 cases (1.1%, 95% confidence interval [ CI ] = 0.26%–2.0%). FFI was the first method chosen (primary FFI ) in 180 encounters (1%, 95% CI = 0.2%–1.8%). The most common indication for FFI was airway obstruction (36.1%, 95% CI = 24.6%–47.7%). For primary FFI , first‐attempt intubation success was 51.1% (95% CI = 43.6%–58.6%), and overall intubation success with FFI was 74.3% (95% CI = 65.7%–82.9%). FFI was used as a rescue airway strategy in 24 cases (0.1% of all encounters) and was successful in 17 of those (70.8%, 95% CI = 65.4%–85.2%). Conclusions Emergency department FFI is uncommon and typically used as a nonsurgical alternative for airway obstruction. First‐attempt ED FFI is successful in half of cases and in two‐thirds of rescue attempts. These data provide an important baseline to help better characterize the nature of FFI as a rare critical procedure in the ED and offer an empiric basis for ongoing discussions on the optimal role of FFI in ED training and practice.