Morbidity related to emergency endotracheal intubation--a substudy of the KETAmine SEDation trial

Resuscitation. 2011 May;82(5):517-22. doi: 10.1016/j.resuscitation.2011.01.015. Epub 2011 Feb 22.


Objectives: To evaluate the association between emergency tracheal intubation difficulty and the occurrence of immediate complications and mortality, when standardised airway management is performed by emergency physicians.

Methods: The present study was a substudy of the KETAmine SEDation (KETASED) trial, which compared morbidity and mortality after randomisation to one of two techniques for rapid sequence intubation in an emergency setting. Intubation difficulty was measured using the intubation difficulty scale (IDS) score. Complications recognised within 5 min of endotracheal intubation were recorded. We used multivariate logistic regression analysis to determine the factors associated with the occurrence of complications. Finally, a Cox proportional hazards regression model was used to examine the association of difficult intubation with survival until 28 days.

Results: A total of 650 patients were included, with mean age of 55 ± 19 years. Difficult intubation (IDS >5) was recorded in 73 (11%) patients and a total of 248 complications occurred in 192 patients (30%). Patients with at least one complication had a significantly higher median IDS score than those without any complications. The occurrence of a complication was independently associated with intubation difficulty (odds ratio 5.9; 95% confidence interval (CI) [3.5;10.1], p < 0.0001) after adjustment on other significant factors. There was a positive linear relationship between IDS score and complication rate (R(2) = 0.83; p < 0.001). The Cox model for 28-day mortality indicated that difficult intubation (hazard ratio 1.59; 95%CI [1.04;2.42], p = 0.03) was a significant independent predictor of death.

Conclusion: Difficult intubation, measured by the IDS score, is associated with increased morbidity and mortality in patients managed under emergent conditions.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Airway Obstruction / surgery*
  • Anesthetics, Dissociative / administration & dosage*
  • Conscious Sedation / methods*
  • Emergencies*
  • Emergency Service, Hospital
  • Female
  • Follow-Up Studies
  • France / epidemiology
  • Hospital Mortality / trends
  • Humans
  • Injections, Intravenous
  • Intubation, Intratracheal / adverse effects*
  • Intubation, Intratracheal / mortality
  • Ketamine / administration & dosage*
  • Larynx / injuries*
  • Male
  • Middle Aged
  • Morbidity / trends
  • Outcome Assessment, Health Care
  • Prospective Studies
  • Risk Factors
  • Single-Blind Method
  • Survival Rate / trends


  • Anesthetics, Dissociative
  • Ketamine