Premium
Multicenter Comparison of Nonsupine Versus Supine Positioning During Intubation in the Emergency Department: A National Emergency Airway Registry ( NEAR ) Study
Author(s) -
Stoecklein H. Hill,
Kelly Christopher,
Kaji Amy H.,
Fantegrossi Andrea,
Carlson Margaret,
Fix Megan L.,
Madsen Troy,
Walls Ron M.,
Brown Calvin A.
Publication year - 2019
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.13805
Subject(s) - medicine , intubation , emergency department , interquartile range , confidence interval , laryngoscopy , supine position , odds ratio , anesthesia , airway , retrospective cohort study , airway management , emergency medicine , surgery , psychiatry
Objective Head‐up positioning for preoxygenation and ramping for morbidly obese patients are well‐accepted techniques, but the effect of head‐up positioning with full torso elevation for all intubations is controversial. We compared first‐pass success, adverse events, and glottic view between supine ( SP ) and nonsupine ( NSP ) positioning for emergency department ( ED ) patients undergoing orotracheal intubation. Methods We performed a retrospective analysis of prospectively collected data for ED intubations over a 2‐year period from 25 participating centers in the National Emergency Airway Registry ( NEAR ). We compared characteristics and outcomes for adult patients intubated orotracheally in SP and NSP positions with either a direct or video laryngoscope. We report odds ratios ( OR ) with 95% confidence interval ( CI ) for categorical variables and interquartile ranges with 95% CI for continuous variables. Our primary outcome was first‐attempt intubation success and secondary outcomes were glottic views and peri‐intubation adverse events. Results Of 11,480 total intubations, 5.8% were performed in NSP . The NSP group included significantly more obese patients ( OR = 2.2 [95% CI = 1.9–2.6]) and patients with a suspected difficult airway ( OR = 1.8 [95% CI = 1.6–2.2]). First‐pass success (adjusted OR = 1.1 [95% CI = 0.9–1.4]) and overall rate of grade I glottic views ( OR = 1.1 [95% CI = 0.9–1.2]) were similar between groups while NSP had a significantly higher rate of grade I views when direct laryngoscopy was employed ( OR = 1.27 [95% CI = 1.04–1.54]). NSP was associated with higher odds of any adverse event ( OR = 1.4 [95% CI = 1.1–1.7]). Conclusions ED providers utilized SP in most ED intubations but were more likely to use NSP for patients who were obese or in whom they predicted a difficult airway. We found no differences in first‐pass success between groups but total adverse events were more likely in NSP . A randomized trial comparing patient positioning during intubation in the ED is warranted.