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Purpose <p>Approximately, 12% of trauma activations require intubation and 25% of all emergency department (ED) intubations are in trauma patients. The first-pass success rate in trauma patient intubation is 64–90%. This study aims to explore factors associated with first-pass success and adverse event rates in trauma patients in a Canadian context.</p> Methods <p>We conducted a health records and registry review of a cohort of trauma patients requiring intubation at two Level 1 trauma sites in British Columbia (January 2017–March 2022). Primary outcome was first-pass success rate. Secondary outcomes were adverse events rates as well as identifying factors associated with first-pass success and adverse events. Multivariate logistic regression explored associations with key covariates and estimated adjusted odds ratios.</p> Results <p>Among 440 patients, 85% experienced first-pass success and 22% experienced adverse events. DASH-1A rates were 72%. Adjusted logistic regression revealed that video laryngoscopy was positively associated with first-pass success (OR 2.38 CI 1.13–4.99 <i>p</i> = 0.02). Trauma to head, face, or neck was negatively associated with first-pass success (OR 0.09 CI 0.01–0.65, <i>p</i> = 0.02). Intubations by junior residents and higher injury severity scores were associated with an increased odds ratio of adverse events (OR 2.12 CI 1.02–4.42 <i>p</i> = 0.05 and OR 1.04 CI 1.02–1.06 <i>p</i> = 0.001 respectively).</p> Conclusions <p>Our project is the first to comprehensively report first-pass success, adverse events, intubation operator/equipment, and trauma characteristics for Canadian trauma patients intubated in the ED. Video laryngoscopy was associated with improved first-pass success, while head, face, or neck trauma was associated with reduced first-pass success. Further, intubations by junior residents and extensive injuries were found to be associated with a greater frequency of adverse events. Ongoing quality improvement and trauma-specific intubation training should continue in order&#xa0;to improve first-pass success, reduce adverse events, and address patient-oriented outcomes.</p>

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Successes and failures of ED trauma intubations

  • 期刊论文

  • 发表日期：

    2026年3月30日

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  • Paul Clerc,
  • Valerie Athaide,
  • John Taylor,
  • Jeff Yoo,
  • Vesna Ivkov,
  • Kuljit Minhas,
  • Elizabeth Rohrs,
  • Samantha Jang-Stewart,
  • Jade Zhong,
  • Regina-Veronicka Kalaydina,
  • Karanvir Gill,
  • Brendan Tao,
  • Celestina Tanase,
  • Victoria Forcina

摘要

Purpose

Approximately, 12% of trauma activations require intubation and 25% of all emergency department (ED) intubations are in trauma patients. The first-pass success rate in trauma patient intubation is 64–90%. This study aims to explore factors associated with first-pass success and adverse event rates in trauma patients in a Canadian context.

Methods

We conducted a health records and registry review of a cohort of trauma patients requiring intubation at two Level 1 trauma sites in British Columbia (January 2017–March 2022). Primary outcome was first-pass success rate. Secondary outcomes were adverse events rates as well as identifying factors associated with first-pass success and adverse events. Multivariate logistic regression explored associations with key covariates and estimated adjusted odds ratios.

Results

Among 440 patients, 85% experienced first-pass success and 22% experienced adverse events. DASH-1A rates were 72%. Adjusted logistic regression revealed that video laryngoscopy was positively associated with first-pass success (OR 2.38 CI 1.13–4.99 p = 0.02). Trauma to head, face, or neck was negatively associated with first-pass success (OR 0.09 CI 0.01–0.65, p = 0.02). Intubations by junior residents and higher injury severity scores were associated with an increased odds ratio of adverse events (OR 2.12 CI 1.02–4.42 p = 0.05 and OR 1.04 CI 1.02–1.06 p = 0.001 respectively).

Conclusions

Our project is the first to comprehensively report first-pass success, adverse events, intubation operator/equipment, and trauma characteristics for Canadian trauma patients intubated in the ED. Video laryngoscopy was associated with improved first-pass success, while head, face, or neck trauma was associated with reduced first-pass success. Further, intubations by junior residents and extensive injuries were found to be associated with a greater frequency of adverse events. Ongoing quality improvement and trauma-specific intubation training should continue in order to improve first-pass success, reduce adverse events, and address patient-oriented outcomes.