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Emergency department adult fiberoptic intubations: Incidence, indications and implications for training

Emily M Hayden, Daniel J Pallin, Susan R Wilcox, James A Gordon, Jestin N Carlson, Ron M Walls, Calvin A Brown
Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine 2018 April 27

BACKGROUND: To describe the frequency, indications and outcomes of flexible fiberoptic intubations (FFI) performed in the emergency department (ED).

METHODS: From the National Emergency Airway Registry (NEAR), we identified all encounters during 7/1/02 through 12/31/12 with the use of FFI. We determined patient, provider and intubation characteristics, success and failure rates, and modes of intubation rescue.

RESULTS: Among 17,910 intubations of patients >15 years old at 13 EDs, FFI was used in 204 cases (1.1%, 95% CI = 0.26%-2.0%). FFI was the first method chosen (primary FFI) in 180 encounters (1%, 95% CI = 0.2%-1.8%). The most common indication for FFI was airway obstruction (36.1%; 95% CI = 24.6%-47.7%). For primary FFI, first attempt intubation success was 51.1% (95% CI = 43.6%-58.6%), and overall intubation success with FFI was 74.3% (95% CI = 65.7%-82.9%). FFI was used as a rescue airway strategy in 24 cases (0.1% of all encounters) and was successful in 17 of those (70.8%; 95% CI = 65.4%-85.2%).

CONCLUSIONS: ED FFI is uncommon, and typically used as a non-surgical alternative for airway obstruction. First attempt ED FFI is successful in half of cases, and in two-thirds of rescue attempts. This data provides an important baseline to help better characterize the nature of FFI as a rare critical procedure in the ED, and offers an empiric basis for ongoing discussions on the optimal role of FFI in ED training and practice. This article is protected by copyright. All rights reserved.


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