Head Up Intubation Improves Success

March 17, 2017

Short Attention Span Summary

Heads up
Recent studies suggest intubation with the head of the bed elevated can help facilitate the procedure.  They performed a prospective observational study of 231 intubations by 58 residents over 5 years.  First-pass success was highest with the upright position (>45°) at 86%, followed by inclined (11-44°) at 78%, then supine (0-10°) at 66%.  Odds of first-pass success increased 11% for every 5° elevation.  They used direct laryngoscopy 79% of the time, video laryngoscopy in 21%.

Spoon Feed
Elevating the head of the bed helped facilitate first-pass success for endotracheal intubation.  JWatch has an excellent summary of this article.

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Abstract

Am J Emerg Med. 2017 Feb 5. pii: S0735-6757(17)30100-6. doi: 10.1016/j.ajem.2017.02.011. [Epub ahead of print]

Feasibility of upright patient positioning and intubation success rates at two academic emergency departments.

Turner JS1, Ellender TJ2, Okonkwo ER3, Stepsis TM4, Stevens AC5, Sembroski EG6, Eddy CS7, Perkins AJ8, Cooper DD9.

Author information:

1Indiana University School of Medicine, Department of Emergency Medicine, United States. Electronic address: turnjose@iu.edu.

2Indiana University School of Medicine, Department of Emergency Medicine, United States. Electronic address: tellende@iu.edu.

3Indiana University School of Medicine, Department of Emergency Medicine, United States; Carolinas Medical Center Emergency Medicine Residency, United States. Electronic address: Enola.okonkwo@gmail.com.

4Indiana University School of Medicine, Department of Emergency Medicine, United States. Electronic address: tstepsis@iu.edu.

5Indiana University School of Medicine, Department of Emergency Medicine, United States; Allina Health, United States. Electronic address: Andrew.stevens@allina.com.

6Indiana University School of Medicine, Department of Emergency Medicine, United States; Southern Illinois University Emergency Medicine Residency, United States. Electronic address: SembroskE@gmail.com.

7Indiana University School of Medicine, Department of Anesthesia, United States. Electronic address: ceddy@iupui.edu.

8Indiana University Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, United States. Electronic address: antperki@iupui.edu.

9Indiana University School of Medicine, Department of Emergency Medicine, United States. Electronic address: ddcooper@iu.edu.

Abstract

OBJECTIVES:

Endotracheal intubation is most commonly taught and performed in the supine position. Recent literature suggests that elevating the patient’s head to a more upright position may decrease peri-intubation complications. However, there is little data on the feasibility of upright intubation in the emergency department. The goal of this study was to measure the success rate of emergency medicine residents performing intubation in supine and non-supine, including upright positions.

METHODS:

This was a prospective observational study. Residents performing intubation recorded the angle of the head of the bed. The number of attempts required for successful intubation was recorded by faculty and respiratory therapists. The primary outcome of first past success was calculated with respect to three groups: 0-10° (supine), 11-44° (inclined), and ≥45° (upright); first past success was also analyzed in 5 degree angle increments.

RESULTS:

A total of 231 intubations performed by 58 residents were analyzed. First pass success was 65.8% for the supine group, 77.9% for the inclined group, and 85.6% for the upright group (p=0.024). For every 5 degree increase in angle, there was increased likelihood of first pass success (AOR=1.11; 95% CI=1.01-1.22, p=0.043).

CONCLUSIONS:

In our study emergency medicine residents had a high rate of success intubating in the upright position. While this does not demonstrate causation, it correlates with recent literature challenging the traditional supine approach to intubation and indicates that further investigation into optimal positioning during emergency department intubations is warranted.

Copyright © 2017 Elsevier Inc. All rights reserved.

PMID: 28202295 [PubMed – as supplied by publisher]