Multiple intubation attempts in the emergency department and in-hospital mortality: A retrospective observational study.

OBJECTIVES: Multiple intubation attempts in the Emergency Department (ED) have been associated with adverse events, but no study examined the influence of multiple intubation attempts on survival during hospitalization. Our aim was to compare one or more intubation attempts in the ED with risk of morbidity and mortality during hospitalization.

METHODS: We conducted a single center retrospective analysis of all patients undergoing emergency intubation in the ED and then admission to the hospital, during September 2010 to April 2016. The primary exposure was multiple intubation attempts. The primary outcome was mortality during hospitalization after intubation in the ED.

RESULTS: Of 181 patients, 63 (35%) required two or more attempts. We found no significant difference in mortality (p = 0.11), discharge from the hospital (p = 0.45), length of stay in hospital (p = 0.34), intensive care unit (ICU) (p = 0.32), ED (p = 0.81) or intubation period (p = 0.64), between one or more intubation attempts. After adjustment for the number of intubation trials, age, sex, intubation methods, first intubator training level and diagnostic category, use of medications during intubation was the only independent prognostic variable for hospital death (adjusted OR 0.21, 95%CI 0.1-0.45, p < 0.01). Number of trials to achieve successful intubation was not associated with discharge disposition (OR 0.77 95%CI 0.24-2.46, p = 0.66). Age (OR 0.95, 95%CI 0.93-0.98, p < 0.01) and brain injury as a diagnostic category (OR 0.15 95%CI 0.04-0.56, p < 0.01) were independent prognostic variables.

CONCLUSIONS: We found multiple intubation attempts were not associated with increased mortality and morbidity during hospitalization.