Emergency airway management in geriatric and younger patients: analysis of a multicenter prospective observational study

• Published in: The American journal of emergency medicine 2013, Vol.31 (1), p.190-196
• Main Authors: Imamura, Taichi, MD, Brown, Calvin A., MD, Ofuchi, Hisashi, MD, Yamagami, Hiroshi, MD, Branch, Joel, MD, Hagiwara, Yusuke, MD, MPH, Brown, David F.M., MD, Hasegawa, Kohei, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Airway Management - adverse effects; Airway Management - methods; Emergency; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Female; Geriatrics - methods; Hospitals; Humans; Japan; Male; Middle Aged; Observation; Observational studies; Older people; Physicians; Prospective Studies
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2012.07.008

Abstract Objectives There is little information on geriatric emergency airway management. We sought to describe intubation practices and outcomes for emergency department (ED) geriatric and younger patients in Japan. Method We formed the Japanese Emergency Airway Network, a consortium of 11 medical centers, and prospectively collected data on ED intubations between 2010 and 2011. All patients 18 years or older who underwent emergent airway management were included in our study. Patients were divided to into 2 groups: 18 to 64-year olds and 65 years or older. We present descriptive data as proportions with 95% confidence intervals (CI). Results The database recorded 3277 patients (capture rate 96%), and 3178 met the inclusion criteria. Of 3178 patients, 1844 (58%) were 65 years or older, 1334 (42%) were 18 to 64 years old, 809 (25%) were 80 years or older, and 407 (50%) of them were in the state of cardiac arrest. The geriatric group, compared to the younger group, had a higher success rate on the initial attempt (71% vs 64%; difference 7%; 95% CI 4%-10%;) and in 2 attempts (90% vs 88%; difference 3%; 95% CI 1%-5%) or less. There was no significant difference in the adverse event rates by age group (difference 0%; 95% CI − 2% to 3%). Conclusion In our multicenter study involving a large geriatric population, we found that geriatric patients were intubated with a higher success rate, compared to younger patients. These data provide implications for the geriatric ED airway practice that may lead to better patient-centered emergency care.