C105-23 Device Versus Intubator Change After An Unsuccessful First Attempt: A National Emergency Airway Registry (NEAR) Analysis

Abstract Rationale Multiple attempts at emergency department (ED) intubation are associated with complications, including peri-intubation cardiac arrest. When the first attempt fails, clinicians must maximize the probability of second-attempt success. We aimed to estimate the association between changing the device (laryngoscope and/or stylet) and intubator with second-attempt success. Methods We analyzed adult (≥14 years old) ED intubations in National Emergency Airway Registry (NEAR) with an unsuccessful first attempt followed by a second attempt. Encounters were categorized as same intubator/same device, same intubator/different device, different intubator/same device, or different intubator/different device. The primary outcome was second-attempt success. We used a Poisson regression model with robust standard errors to estimate adjusted risk ratios (aRR) for second-attempt success. The model adjusted for patient factors (body habitus, blood in airway) and characteristics of the first attempt: use of video laryngoscopy, use of bougie, Cormack-Lehane view, intubator training level (postgraduate year), and occurrence of an adverse event (vomiting, esophageal intubation, brady-/tachydysrhythmia, cardiac arrest, hypoxemia, or hypotension). Results Of 19,071 ED intubation encounters, 2,022 were eligible. Residents performed 96.5% of first (n = 1,952) and 84.8% of second (n = 1,715) attempts; video laryngoscopy use increased from 51.2% (n = 1,036) to 69.8% (n = 1,411), respectively. Second-attempt success rates were 75.4% (same intubator/same device), 82.2% (different intubator/same device), 77.1% (same intubator/different device), and 79.1% (different intubator/different device). Compared with the reference group (same intubator/same device), second-attempt success was significantly higher for different intubator/same device (aRR 1.13, 95% CI 1.05-1.22) and different intubator/different device (aRR 1.09, 95% CI 1-1.19). No significant difference was found for same intubator/different device (aRR 1.05, 95% CI 0.99-1.12). Conclusion Among ED intubations predominantly performed by residents, changing the intubator (with or without a new device) after an unsuccessful first attempt was associated with higher second-attempt success. Changing the device alone was not. This abstract is funded by: None