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Risk factors for failed first intubation attempt in an out-of-hospital setting: a multicenter prospective study

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Abstract

This study was performed to identify variables potentially associated with failure of the first intubation attempt in an out-of-hospital emergency setting, considering all aspects of tracheal intubation. This observational prospective multicenter study was performed over 17 months and involved 10 prehospital emergency medical units. After each tracheal intubation, the operator was required to provide information concerning operator and patient characteristics, as well as the environmental conditions during intubation, by completing a data collection form. The primary endpoint was failure of the first intubation attempt. During the study period, 1546 patients were analyzed, of whom 59% were in cardiac arrest; 486 intubations failed on the first attempt (31.4% [95% confidence interval = 30.2–32.6]). Multivariate analysis revealed that the following 7 of 28 factors were associated with an increased risk of a failed first intubation attempt: operator with fewer than 50 prior intubations (odds ratio [OR] = 1.8 [1.4–2.4]), small inter-incisor space (OR = 2.3 [1.7–3.2]), limited extension of the head (OR = 1.6 [1.1–2.1]), macroglossia (OR = 2.3 [1.6–3.2]), ear/nose/throat (ENT) tumor (OR = 4.4 [1.4–13.4]), cardiac arrest (OR = 1.8 [1.3–2.6]), and vomiting (OR = 1.7 [1.3–2.3]). The frequency of adverse events among non-cardiac arrest patients was 17.6%; it increased with each additional intubation attempt. The first intubation attempt failed in more than 30% of cases, and seven variables were associated with increased risk of failure. Most of these factors could not be predicted.

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Authors and Affiliations

  1. Pôle Urgences adultes – SAMU, Hôpital Pellegrin, CHU de Bordeaux, 33076, Bordeaux Cedex, France

    Michel Galinski, Romain Boyer, Pierre Catoire, Xavier Combes, Bruno Simonnet & Cédric Gil-jardiné

  2. INSERM U1219, Bordeaux Population Health Research Centre, IETO Team, Bordeaux University-ISPED, Bordeaux, France

    Michel Galinski, Pierre Catoire, Xavier Combes & Cédric Gil-jardiné

  3. Pôle Urgences – SAMU 64, Centre hospitalier de Pau, 64000, Pau, France

    Marion Wrobel

  4. AP-HP, SAMU 92, Hôpital Raymond Poincaré, 92380, Garches, France

    Paul Georges Reuter

  5. Inserm, Équipe Soins Primaires Et Prévention, CESP, Université Paris-Saclay, UVSQ, Univ. Paris-Sud, 94807, Villejuif, France

    Paul Georges Reuter

  6. SMUR de Gonesse, Centre Hospitalier, 95503, Gonesse, France

    Mirko Ruscev

  7. SAMU 38 Hôpital La Tronche, CHU de Grenoble, 38000, Grenoble, France

    Guillaume Debaty

  8. SAMU 69 Hôpital Edouard Herriot, CHU de Lyon, 69000, Lyon, France

    Gilles Bagou

  9. Pôle Urgences – SAMU 31, Hôpital Purpan, CHU de Toulouse, 31000, Toulouse, France

    Emilie Dehours

  10. Pôle Urgences – SMUR, Hôpital Robert Boulin, 33243, Libourne, France

    Juliane Bosc

  11. Pôle Urgences – SAMU 24, Hôpital de Périgueux, 24000, Périgueux, France

    Jean-Paul Lorendeau

  12. Pôle Urgences – SAMU 21, CHU de Dijon, 21000, Dijon, France

    Sybille Goddet

  13. Pôle Urgences – SAMU 49, CHU d’Angers, 49000, Angers, France

    Kamelia Marouf

Authors
  1. Michel Galinski
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  2. Marion Wrobel
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  3. Romain Boyer
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  4. Paul Georges Reuter
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  5. Mirko Ruscev
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  6. Guillaume Debaty
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  7. Gilles Bagou
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  8. Emilie Dehours
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  9. Juliane Bosc
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  11. Sybille Goddet
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  12. Kamelia Marouf
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  13. Pierre Catoire
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  14. Xavier Combes
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  15. Bruno Simonnet
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  16. Cédric Gil-jardiné
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Contributions

MG, CG-J, and BS conceived the study, designed the trial. MG, MW, RB and BS supervised the conduct of the trial and data collection. MG, PC and CG-J undertook recruitment of participating centers. RB, PGR, MR, GD, GB, ED, JB, J-PL, SG, KM undertook recruitment of patients and managed the data, including quality control. MG, XC, CG-J analyzed the data. MG drafted the manuscript, and all authors contributed substantially to its revision. MG takes responsibility for the paper as a whole. All authors read and approved the final manuscript. The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see: http://www.textcheck.com/certificate/huNK0X

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Correspondence to Michel Galinski.

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Galinski, M., Wrobel, M., Boyer, R. et al. Risk factors for failed first intubation attempt in an out-of-hospital setting: a multicenter prospective study. Intern Emerg Med 18, 265–272 (2023). https://doi.org/10.1007/s11739-022-03120-8

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  • DOI: https://doi.org/10.1007/s11739-022-03120-8

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