Factors associated with successful rescue intubation attempts in the emergency department: an analysis of multicenter prospective observational study in Japan

AIM: It remains unclear whether physicians should change intubation approaches after the failed first attempt. We aimed to determine the rescue intervention approaches associated with a higher success rate at the second attempt in the emergency department (ED). METHODS: We analyzed the data from a prospective, multicenter, observational study – the second Japanese Emergency Airway Network Study. The current analysis included all patients who underwent emergency intubation from February 2012 through November 2017. We defined a rescue intubation attempt as a second intubation attempt with any change in intubation approaches (i.e., change in methods, devices, or intubators) from the failed first attempt. The outcome measure was second‐attempt success. RESULTS: Of 2,710 patients with a failed first attempt, 43% underwent a second intubation attempt with changes in intubation approach (i.e., rescue intubation). Rescue intubation attempts were associated with a higher second‐attempt success rate compared to non‐rescue intubation attempts (adjusted odds ratio [OR], 1.78; 95% confidence interval [CI], 1.50–2.12). The rescue intubation approaches associated with a higher second‐attempt success were changes from non‐rapid sequence intubation (RSI) to RSI (adjusted OR, 2.04; 95% CI, 1.12–3.75), from non‐emergency medicine (EM) residents to EM residents (adjusted OR, 2.02; 95% CI, 1.44–2.82), and from non‐EM attending physicians to EM attending physicians (adjusted OR, 2.82; 95% CI, 2.14–3.71). CONCLUSIONS: In this large multicenter study, rescue interventions were associated with a higher second‐attempt success rate. The data also support the use of RSI and backup by EM residents or EM attending physicians to improve the airway management performance after a failed attempt in the ED.