Trauma airway management in emergency departments: a multicentre, prospective, observational study in Japan

Abstract

Objectives: Although successful airway management is essential for emergency trauma care, comprehensive studies are limited. We sought to characterise current trauma care practice of airway management in the emergency departments (EDs) in Japan. Design: Analysis of data from a prospective, observational, multicentre registry—the Japanese Emergency Airway Network (JEAN) registry. Setting: 13 academic and community EDs from different geographic regions across Japan. Participants: 723 trauma patients who underwent emergency intubation from March 2010 through August 2012. Outcome measures ED characteristics, patient and operator demographics, methods of airway management, intubation success or failure at each attempt and adverse events. Results: A total of 723 trauma patients who underwent emergency intubation were eligible for the analysis. Traumatic cardiac arrest comprised 32.6% (95% CI 29.3% to 36.1%) of patients. Rapid sequence intubation (RSI) was the initial method chosen in 23.9% (95% CI 21.0% to 27.2%) of all trauma patients and in 35.5% (95% CI 31.4% to 39.9%) of patients without cardiac arrest. Overall, intubation was successful in ≤3 attempts in 96% of patients (95% CI 94.3% to 97.2%). There was a wide variation in the initial methods of intubation; RSI as the initial method was performed in 0–50.9% of all trauma patients among 12 EDs. Similarly, there was a wide variation in success rates and adverse event rates across the EDs. Success rates varied between 35.5% and 90.5% at the first attempt, and 85.1% and 100% within three attempts across the 12 EDs. Conclusions: In this multicentre prospective study in Japan, we observed a high overall success rate in airway management during trauma care. However, the methods of intubation and success rates were highly variable among hospitals.