Awake intubations in the emergency department: A report from the National Emergency Airway Registry

• Published in: The American journal of emergency medicine 2021-11, Vol.49, p.48-51
• Main Authors: Kaisler, Maria C., Hyde, Robert J., Sandefur, Benjamin J., Kaji, Amy H., Campbell, Ronna L., Driver, Brian E., Brown, Calvin A.
• Format: Article
• Language: English
• Subjects: Airway management; Anesthesia; Angioedema; Awake; Data collection; Drug dosages; Edema; Emergency medical care; Endoscopes; Endotracheal; Intubation; NEAR; Patients; Physicians; Respiratory tract; Skills; Success; Topical medication
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2021.05.038

To describe awake intubation practices in the emergency department (ED) and report success, complications, devices used, and rescue techniques using multicenter surveillance. We analyzed data from the National Emergency Airway Registry (NEAR). Patients with an awake intubation attempt between January 1, 2016 and December 31, 2018 were included. We report univariate descriptive data as proportions with cluster-adjusted 95% confidence intervals (CIs). Of 19,071 discrete patient encounters, an awake technique was used on the first attempt in 82 (0.4%) patients. The majority (91%) of first attempts were performed by emergency medicine physicians. Angioedema (32%) and non-angioedema airway obstruction (31%) were the most common indications for an awake intubation attempt. The most common initial device used was a flexible endoscope (78%). Among all awake intubations first-attempt success was achieved in 85% (95% CI [76%–95%]), and peri-intubation complications occurred in 16% (95% CI [9%–26%]). Awake intubation in this multicenter cohort of emergency department patients was rare and was performed most often in patients with airway edema or obstruction. Emergency physicians performed the majority of first intubation attempts with high first-attempt success. Further studies are needed to determine optimal emergency airway management in this patient population. •Awake intubations were performed in only 0.4% of emergency department intubations.•The majority of awake intubations were performed by emergency physicians.•First-attempt success for awake intubation techniques was 84%.•One patient required surgical airway.