Advanced airway management: a descriptive analysis of complications and factors associated with first-attempt intubation failure in prehospital emergency care

Objectives.

To analyze the characteristics of prehospital emergency airway management, including complications; to explore predictors of first-attempt failure of orotracheal intubation.

Methods.

Observational retrospective cohort study of patients requiring orotracheal intubation by the prehospital emergency services of Castile–La Mancha between June 1, 2017, and January 1, 2021. We analyzed patient and procedure characteristics and complications using logistic regression analysis to detect factors that could predict firstattempt intubation failure.

Results.

A total of 425 patients were included; 417 (98.1%) were intubated successfully, including 326 (76.7%) on the first attempt. Complications occurred in 183 intubations in 94 patients (22.1%). Predictors of first-attempt failure were age over 55 years (odds ratio [OR], 1.94; 95% CI, 1.10–4.23), body mass index over 30 (OR, 9.14; 95% CI,

4.40–19.00), oxygen saturation less than 90% (OR, 3.33; 95% CI, 1.06–10.58), a Glasgow Coma Score between 9 and 13 (OR, 1.58; 95% CI, 1.28–6.9), intubation in a public place (OR, 2.99; 95% CI, 1.42–6.29), intubation done in any other than standing position (OR, 2.09; 95% CI, 1.08–7.25), direct laryngoscopy (OR, 2.39; 95% CI, 1.20– 6.55),

use of a stylet (OR, 1.80; 95% CI, 1.40–3.78), and a Cormack–Lehane classification of 2 or higher (OR, 6.50; 95% CI, 3.96–30.68).

Conclusions.

Orotracheal intubation is generally accomplished on the first attempt. Factors associated with first-attempt failure can facilitate tailored approaches to upper airway management.