Prevalence of difficult airway predictors in cases of failed prehospital endotracheal intubation

J Emerg Med. 2014 Sep;47(3):294-300. doi: 10.1016/j.jemermed.2014.04.021. Epub 2014 Jun 3.


Background: Difficult airway predictors (DAPs) are associated with failed endotracheal intubation (ETI) in the emergency department (ED). However, little is known about the relationship between DAPs and failed prehospital ETI.

Objective: Our aim was to determine the prevalence of common DAPs among failed prehospital intubations.

Methods: We reviewed a quality-improvement database, including all cases of ETI in a single ED, over 3 years. Failed prehospital (FP) ETI was defined as a case brought to the ED after attempted prehospital ETI, but bag-valve-mask ventilation, need for a rescue airway (supraglottic device, cricothyrotomy, etc.), or esophageal intubation was discovered at the ED. Physicians performing ETI evaluated each case for the presence of DAPs, including blood/emesis, facial/neck trauma, airway edema, spinal immobilization, short neck, and tongue enlargement.

Results: There were a total of 1377 ED ETIs and 161 had an FP-ETI (11.8%). Prevalence of DAPs in cases with FP-ETI was obesity 13.0%, large tongue 18.0%, short neck 13%, small mandible 4.3%, cervical immobility 49.7%, blood in airway 57.8%, vomitus in airway 23.0%, airway edema 12.4%, and facial or neck trauma 32.9%. The number of cases with FP-ETI and 0, 1, 2, 3, or 4 or more DAPs per case was 22 (13.6%), 43 (26.7%), 23 (24.3%), 42 (26.1%), and 31 (19.3%), respectively.

Conclusions: DAPs are common in cases of FP-ETI. Some of these factors may be associated with FP-ETI. Additional study is needed to determine if DAPs can be used to identify patients that are difficult to intubate in the field.

Keywords: airway management; complications; difficult; endotracheal intubation; failure; prehospital; success.

MeSH terms

  • Adult
  • Aged
  • Airway Management / methods*
  • Emergency Medical Services / methods
  • Emergency Medical Services / statistics & numerical data*
  • Female
  • Humans
  • Intubation, Intratracheal / statistics & numerical data*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prevalence
  • Retrospective Studies
  • Risk Factors
  • Treatment Failure
  • Young Adult