Endotracheal intubation in the emergency room: a multicenter questionnaire

Introduction

Endotracheal intubation (ETI) engages the patient's life and demands a good experience. A preliminary prospective study has shown in one hospital that emergency physicians (EPs) rarely performed ETI. Do the EPs in Ile de France (Paris region) have sufficient experience and regular training to realise this procedure safely in the emergency room (ER)?

Methods

We conducted a descriptive telephone-based questionnaire study to assess EPs' endotracheal intubation skills through all ERs in Ile de France public hospitals. A questionnaire was completed by the investigator during a 10-minute telephone call with at least one EP in each ER. The structure of hospitals, number of ETIs performed, devices and personnel available and the existence of protocols were collected. Their usual practice of sedation and intubation, training and proposals for changes were noted.

Results

The study was made through all of the 64 public hospitals of Ile de France. Fifty-six hospitals have an ICU, 37 a mobile ICU. We questioned 96 EPs; that is, 10% of EPs from our region. All of the 96 EPs called responded. These physicians were certified emergency physicians (CAMU) for 90% of them. The median of ETI declared was 24.5/year per ER. Thirty-eight percent of EPs performed less than five ETIs during the past 2 years. The success rate reported was 85%. In 94% of ERs, metallic blades and Eischmann mandrin were available and about two nurses can help during the procedure. Predictive criteria for difficult ETI cited the most were: short neck, obesity, small mouth opening and otorhinolaryngology disease or previous history of cervical radiotherapy. Seventy-six percent of EPs followed the recommendations for preoxygenation and 91% performed rapid sequence induction. The vast majority (76%) of ERs did not have standardized procedures for airway management. Theoretical training was acquired for 46% of EPs by the CAMU, practical training occurring in the operating room for 71%. Among the EPs interviewed, 87% believe that they should remain the principal actor for ETI – although as high as 89% of them consider that they were insufficiently trained in ETI management and only 41% pursued continuing medical education on that theme. Seventy-seven percent proposed to spend time in the operating room to improve their practice of ETI.

Conclusion

ETI is rarely performed in the ER. It should be part of the EP curricula and written procedures should be made.