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Observational Study
. 2019 Feb 14;27(1):20.
doi: 10.1186/s13049-019-0599-1.

Airway Management in the Emergency Department (The OcEAN-Study) - a prospective single centre observational cohort study

Michael Bernhard  1   2   3 , Sönke Nils Bax  4   5 , Thomas Hartwig  2 , Maryam Yahiaoui-Doktor  6 , Sirak Petros  7 , Sven Bercker  8 , Alexandra Ramshorn-Zimmer  2 , André Gries  2
Affiliations
Observational Study

Airway Management in the Emergency Department (The OcEAN-Study) - a prospective single centre observational cohort study

Michael Bernhard et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Emergency airway management (AM) is a major key for successful resuscitation of critically ill non-traumatic (CINT) patients. Details of the AM of these patients in German emergency departments (ED) are unknown. This observational study describes epidemiology, airway techniques, success rates and complications of AM in CINT ED patients in the resuscitation room (RR).

Methods: Data was collected prospectively on adult CINT patients admitted to the RR of a single German university ED September 2014 to August 2015. Patient characteristics, out-of-hospital and in-hospital RR AM, complications and success rates were recorded using a self-developed airway registry form.

Results: During the study period 34,303 patients were admitted to the ED, out of those 21,074 patients for non-trauma emergencies. Suffering from severe acute life-threatening problems, 532 CINT patients were admitted to the RR. 150 (28.2%) CINT patients had received out-of-hospital AM. In 16 of these cases (10.7%) the inserted airway needed to be changed after RR admission (unrecognized oesophageal intubation: n = 2, laryngeal tube exchange: n = 14). 136 (25.6%) CINT patients without out-of-hospital AM received RR AM immediately after admission. The first-pass and overall success rate in the RR were 71 and 100%, respectively, and multiple intubation attempts were necessary in 29%. A lower Cormack/Lehane (C/L) grade was associated with less intubation attempts (C/L1/2 vs. 3/4: 1.2 ± 0.5 vs. 1.8 ± 1.2, p = 0.0002). Complication rate was 43%.

Conclusions: OcEAN demonstrates the challenges of AM in CINT patients in a German ED RR. We propose a nation-wide ED airway registry to better track outcomes in the future.

Keywords: Airway management; Complications; Emergency department; First-pass success; Resuscitation room.

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Conflict of interest statement

Ethics approval and consent to participate

The OcEAN study was approved by the ethical committee of the Medical Faculty of the University of Leipzig, Germany (265–14-25,082,014).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study cohort: ED = emergency department, CINT = critically ill non-traumatic, RR = resuscitation room
Fig. 2
Fig. 2
Number of mean intubations attempts according to intubations conditions and Cormack/Lehane grade. MV = mean value, SD = standard deviation
See this image and copyright information in PMC

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