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Multicenter Study
. 2022 May 28;22(1):91.
doi: 10.1186/s12873-022-00644-2.

National Emergency Resuscitation Airway Audit (NERAA): a pilot multicentre analysis of emergency intubations in Irish emergency departments

Etimbuk Umana  1   2 , James Foley  3   4 , Irene Grossi  5 , Conor Deasy  3   6 , Francis O'Keeffe  7 ; Irish Trainee Emergency Research Network (ITERN) Collaborators
Collaborators, Affiliations
Multicenter Study

National Emergency Resuscitation Airway Audit (NERAA): a pilot multicentre analysis of emergency intubations in Irish emergency departments

Etimbuk Umana et al. BMC Emerg Med. .

Abstract

Background: There is paucity of literature on why and how patients are intubated, and by whom, in Irish Emergency Departments (EDs). The aim of this pilot study was to characterise emergency airway management (EAM) of critically unwell patients presenting to Irish EDs.

Methods: A multisite prospective pilot study was undertaken from February 10 to May 10, 2020. This project was facilitated through the Irish Trainee Emergency Research Network (ITERN). All patients over 16 years of age requiring EAM were included. Eleven EDs participated in the project. Data recorded included patients' demographics, indication for intubation, technique of airway management, medications used to facilitate intubation, level of training and specialty of the intubating clinician, number of attempts, success/complications rates and variation across centres.

Results: Over a 3-month period, 118 patients underwent 131 intubation attempts across 11 EDs. The median age was 57 years (IQR: 40-70). Medical indications were reported in 83% of patients compared to 17% for trauma. Of the 118 patients intubated, Emergency Medicine (EM) doctors performed 54% of initial intubations, while anaesthesiology/intensive care medicine (ICM) doctors performed 46%. The majority (90%) of intubating clinicians were at registrar level. Emergency intubation check lists, video laryngoscopy and bougie were used in 55, 53 and 64% of first attempts, respectively. The first pass success rate was 89%. Intubation complications occurred in 19% of patients. EM doctors undertook a greater proportion of intubations in EDs with > 50,000 attendance (65%) compared to EDs with < 50,000 attendances (16%) (p < 0.000).

Conclusion: This is the first study to describe EAM in Irish EDs, and demonstrates comparable first pass success and complication rates to international studies. This study highlights the need for continuous EAM surveillance and could provide a vector for developing national standards for EAM and EAM training in Irish EDs.

Keywords: Airway management; Emergency department; Intubation; Rapid sequence induction.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of intubation attempts. (EAM – emergency airway management, LMA – laryngeal mask airway)
Fig. 2
Fig. 2
Intubation complication [23 patients (19%)]. Other = Cardiac arrest patient with failed first attempt and LMA (laryngeal mask airway) subsequently inserted for remainder of arrest (Patient died in ED)
See this image and copyright information in PMC

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