Arulkumaran, N; McLaren, CS; Arulkumaran, K; Philips, BJ; Cecconi, M; (2018) An analysis of emergency tracheal intubations in critically ill patients by critical care trainees. Journal of the Intensive Care Society , 19 (3) pp. 180-187. 10.1177/1751143717749686.

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Abstract

Introduction: We evaluated intensive care medicine trainees' practice of emergency intubations in the United Kingdom. Methods: Retrospective analysis of 881 in-hospital emergency intubations over a three-year period using an online trainee logbook. Results: Emergency intubations out-of-hours were less frequent than in-hours, both on weekdays and weekends. Complications occurred in 9% of cases, with no association with time of day/day of week (p = 0.860). Complications were associated with higher Cormack and Lehane grades (p=0.004) and number of intubation attempts (p < 0.001), but not American Society of Anesthesiologist grade. Capnography usage was ≥99% in all locations except in wards (85%; p = 0.001). Ward patients were the oldest (p < 0.001), had higher American Society of Anesthesiologist grades (p < 0.001) and lowest Glasgow Coma Scale (p < 0.001). Conclusions: Complications of intubations are associated with higher Cormack and Lehane grades and number of attempts, but not time of day/day of week. The uptake of capnography is reassuring, although there is scope for improvement on the ward.

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