Published in:
01-07-2017 | Correspondence
Effects of training on resident physician emergency airway management skills
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 7/2017
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Emergency airway management is necessary when patients develop acute cardiopulmonary failure. Early intubation prevents hypoxemia from a poor bag-mask seal, but multiple intubation attempts increase the risk of complications.1‐3 The Canadian Airway Focus Group summarizes the adverse effects associated with multiple intubation attempts in Table 3 of their 2013 publication on difficult tracheal intubation in the unconscious patient.4 Highly trained residents in supervised intensive care settings have previously been studied. 1‐3
Table
Patient demographics and status of first-intubation care provider attempts (n = 218 patients)
|
Total cohort (n = 218)
|
First attempt by training level
|
First attempt by training specialty
|
|||
|---|---|---|---|---|---|
|
Parameter
|
n (%)
|
PGY 1 (n = 37)
|
PGY ≥2 (n = 181)
|
Non-anesthesiology (n = 122)
|
Anesthesiology (n = 96)
|
|
Age, mean (SD)
|
66.0 (14.9)
|
67.5 (15.9)
|
65.7 (14.8)
|
66.0 (15.5)
|
66.1 (14.3)
|
|
Female sex
|
107 (49%)
|
17 (46%)
|
90 (50%)
|
61 (50%)
|
46 (48%)
|
|
Reason for intubation
|
|||||
|
Cardiac arrest
|
139 (64%)
|
17 (46%)
|
122 (67%)
|
57 (47%)
|
82 (86%)
|
|
Respiratory failure
|
29 (13%)
|
7 (19%)
|
22 (12%)
|
25 (20%)
|
4 (4%)
|
|
Other (neurologic, mixed)
|
23 (11%)
|
8 (22%)
|
15 (8%)
|
18 (15%)
|
5 (5%)
|
|
Not indicated
|
27 (12%)
|
5 (13%)
|
22 (12%)
|
22 (18%)
|
5 (5%)
|
|
Intubation technique
|
|||||
|
Direct laryngoscopy
|
209 (96%)
|
33 (89%)
|
176 (97%)
|
117 (96%)
|
92 (96%)
|
|
Other
|
9 (4%)
|
4 (11%)
|
5 (3%)
|
5 (4%)
|
4 (4%)
|
|
Number of intubation attempts
|
|||||
|
One
|
158 (72%)
|
16 (43%)
|
142 (78%)
|
80 (66%)
|
78 (81%)
|
|
Two
|
33 (15%)
|
12 (32%)
|
21 (12%)
|
21 (17%)
|
12 (13%)
|
|
≥ 3
|
27 (12%)
|
9 (24%)
|
18 (10%)
|
21 (17%)
|
6 (6%)
|
|
Complications
|
|||||
|
Esophageal intubation
|
42 (19%)
|
14 (37%)
|
28 (15%)
|
34 (28%)
|
8 (8%)
|
|
Regurgitation
|
35 (16%)
|
6 (16%)
|
29 (16%)
|
19 (16%)
|
16 (17%)
|
|
Aspiration
|
26 (12%)
|
5 (14%)
|
21 (12%)
|
15 (12%)
|
11 (11%)
|