Written by Shannon Markus
Spoon Feed
In this cohort of trauma patients requiring intubation, video laryngoscopy was associated with higher first-pass success, while head, face, or neck trauma was associated with lower success. Adverse events were more common with less experienced residents and greater injury severity.
Don’t let trauma airways traumatize you
This retrospective cohort study of 440 trauma intubations across two Canadian Level 1 centers found an 85% first-pass success rate and 22% adverse event rate. Video laryngoscopy was associated with improved first-pass success (OR 2.38), while head, face, or neck trauma markedly reduced success (OR 0.09). Adverse events were defined as hypotension (< 90 mmHg), hypoxemia (< 92%), esophageal intubation, endobronchial intubation, aspiration, airway/dental trauma, cardiac arrest, and inability to intubate. These adverse events were more frequent with increasing attempts, junior operator level, and higher injury severity. Definitive airway without hypoxia/hypotension on first attempt (DASH-1A) occurred in ~72% of cases. Findings reinforce that trauma airway management carries substantial risk, with both patient factors and operator experience influencing outcomes. This supports ongoing quality improvement and targeted airway training, especially in trauma settings.
How does this change my practice?
Head/face/neck trauma? I’m mentally upgrading that airway to “this could go sideways fast.” Practically, that means extra hands, verbalizing the backup plan out loud, and suction actually ready (large bore if possible). If it’s trauma, I’m reaching for video laryngoscopy early and often. At my teaching site, residents are the primary operators with my oversight. As this study reinforces the higher risk of adverse events with less experience, I’m leaning into pre-briefs, deliberate pre-arrival procedure rehearsals, and clearly defined attending takeover points.
Source
Successes and failures of ED trauma intubations. CJEM. 2026 Mar 30. doi: 10.1007/s43678-026-01153-y. Epub ahead of print. PMID: 41913043.
