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A Simple Way to Improve ETT First-Pass Success

October 5, 2020

Written by Clay Smith

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Airway education and a periprocedural checklist were associated with improved endotracheal intubation first-pass success.

Why does this matter?
First-pass success for endotracheal intubation is important for safety. Here is a way to increase the chances of success on the first try.

Makin’ a list, checkin’ it twice
This was a prospective cohort study that enrolled 573 patients with intubation attempts in the ED at a single center both before (for 6 months) and after (for 18 months) a bundle of airway interventions were implemented. The bundle included a monthly airway audit, targeted monthly airway education, and initiation of an airway checklist. First-pass success rose from 88.5% pre-intervention to 94.6% post-intervention, RR 1.07 (95%CI 1.00 to 1.14, p=0.014). Use of the CMAC and bougie were higher in the post-intervention group, which may have also impacted first-pass success. Periprocedural checklists have been repeatedly shown to improve surgical outcomes. Here is yet another example. The checklist combined with audit and education in a bundle is an effective way to improve safety with airway management in the ED.

Here is the checklist they used.

From cited article, supplementary appendix

Impact of a targeted bundle of audit with tailored education and an intubation checklist to improve airway management in the emergency department: an integrated time series analysis. Emerg Med J. 2020 Sep;37(9):576-580. doi: 10.1136/emermed-2019-208935. Epub 2020 Jun 17.

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