Can Community ER Docs Intubate Successfully?

Written by Jason Lesnick 

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This retrospective chart review summarizes endotracheal intubation data and trends from 15 community EDs. Use of video laryngoscopy (VL) and rocuronium increased over this time in this data set.

Community docs are crushing it! 
This chart review evaluated airway management trends and outcomes in community EDs, which the authors correctly note is an underrepresented setting in existing airway literature.

They conducted a retrospective multicenter chart review of 11,475 intubations across 15 Southern California community EDs from 2015–2022. Only two of these EDs had residents rotate through them, but all 15 were owned by a single healthcare system. 

The key findings from this study were that VL use rose from 27.4% of intubations to 77.7% (Δ50.3%, 95%CI 44.2–56.4) and rocuronium use rose from 33.9% to 61.9% (Δ28%, 95%CI 21.1–34.9%) and has passed succinylcholine to become the preferred paralytic.

There are multiple other interesting findings from the study: 

• Patients being intubated in these community EDs were sick, with a one-year all-cause mortality of 45.4%.
• First-pass success was 80.5% with failure at 0.2%; this compares well to NEAR intubation studies that showed a first-attempt success rate of 83% and a failure rate of 0.6%.
• Pediatric intubations made up 2.4% of all intubations (95%CI 2.1 to 2.7).
• 11.4% (95%CI 10.8 to 12.0) of intubations were performed during CPR.

How will this change my practice?
This provides me with unique information about community ED intubation practices. It’s encouraging to see how well they perform. I’m curious to see how my healthcare system’s numbers would compare!

Source
Intubation Practices in Community Emergency Departments. Ann Emerg Med. 2025 Aug;86(2):169-174. doi: 10.1016/j.annemergmed.2024.11.021. Epub 2025 Jan 10. PMID: 39797884.