Multiple failed intubation attempts are associated with decreased success rates on the first rescue intubation in the emergency department: a retrospective analysis of multicentre observational data

Goto, Tadahiro; Gibo, Koichiro; Hagiwara, Yusuke; Morita, Hiroshi; Brown, David FM; Brown, Calvin A; Hasegawa, Kohei

doi:10.1186/s13049-014-0085-8

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Table 3 Multivariable associations of number of failed attempts before first rescue intubation with success rates

From: Multiple failed intubation attempts are associated with decreased success rates on the first rescue intubation in the emergency department: a retrospective analysis of multicentre observational data

	Primary analysis	Sensitivity analysis
	(No. of failed attempts as categorical variable)	(No. of failed attempts as dichotomous variable)	(No. of failed attempts as ordinal variable)
Variables	OR (95% CI)	OR (95% CI)	OR (95% CI)
Primary exposure
Number of failed attempts
(categorical variable)
1	1 [reference]	1 [reference]	1 [reference]
2	0.56 (0.41-0.77)	-	-
3 or more	0.49 (0.25-0.94)	-	-
≥2 (delayed intubation)*	-	0.55 (0.40-0.75)	-
Number of failed attempts (ordinal variable: OR per each incremental attempt)	-	-	0.60 (0.38-0.96)
Age
0-19	0.84 (0.40-1.80)	0.84 (0.40-1.78)	0.84 (0.40-1.80)
20-39	0.82 (0.48-1.41)	0.82 (0.48-1.40)	0.82 (0.48-1.41)
40-59	1.09 (0.69-1.74)	1.09 (0.69-1.74)	1.09 (0.69-1.74)
60-79	1.22 (0.81-1.82)	1.22 (0.81-1.82)	1.22 (0.81-1.82)
80-99	1 [reference]	1 [reference]	1 [reference]
Sex
Male	1 [reference]	1 [reference]	1 [reference]
Female	0.87 (0.64-1.18)	0.87 (0.64-1.18)	0.87 (0.64-1.18)
Primary indication
Cardiac arrest	1 [reference]	1 [reference]	1 [reference]
Medical encounter	0.70 (0.49-1.01)	0.70 (0.49-1.00)	0.70 (0.49-1.01)
Trauma encounter	0.48 (0.30-0.76)	0.48 (0.30-0.76)	0.48 (0.30-0.76)
Change in method
No change	1 [reference]	1 [reference]	1 [reference]
Rapid sequence intubation	0.60 (0.26-1.41)	0.61 (0.26-1.41)	0.61 (0.26-1.41)
Sedation without paralytics	0.26 (0.08-0.88)	0.26 (0.08-0.88)	0.26 (0.08-0.88)
Surgical cricothyrotomy	1.96 (0.42-9.07)	1.96 (0.42-9.04)	1.96 (0.42-9.04)
Others†	0.82 (0.23-2.95)	0.81 (0.22-2.94)	0.82 (0.23-2.95)
Change in device
No change	1 [reference]	1 [reference]	1 [reference]
Direct laryngoscope	1.51 (0.59-3.86)	1.50 (0.59-3.85)	1.51 (0.59-3.86)
Gum elastic bougie	0.85 (0.41-1.77)	0.85 (0.41-1.77)	0.85 (0.41-1.77)
Video laryngoscope	0.47 (0.22-0.96)	0.46 (0.22-0.96)	0.47 (0.22-0.96)
Fiberoptic bronchoscope	0.23 (0.06-0.93)	0.23 (0.06-0.94)	0.23 (0.06-0.93)
Others‡	1.87 (0.20-17.39)	1.89 (0.20-17.59)	1.87 (0.20-17.45)
Change in intubator
No change	1 [reference]	1 [reference]	1 [reference]
Transitional year resident§	0.25 (0.09-0.65)	0.25 (0.09-0.65)	0.25 (0.09-0.65)
Emergency medicine resident	0.89 (0.45-1.77)	0.89 (0.45-1.76)	0.90 (0.45-1.78)
Emergency physician¶	1.15 (0.60-2.19)	1.14 (0.60-2.18)	1.15 (0.60-2.19)
Other specialty	0.70 (0.34-1.47)	0.70 (0.34-1.47)	0.70 (0.34-1.47)

Abbreviations: OR, odds ratio; CI, confidence intervals.
*Delayed rescue intubation was defined as the first rescue intubation attempt after two or more failed attempts.
†Defined as nasal intubation or paralytics without sedatives.
‡Defined as other types of direct laryngoscope, or supraglottic devices.
§Defined as post graduate years 1 or 2.
¶Defined as post graduate years ≥6.

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