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Routinely pausing chest compressions during cardiac arrest to intubate in the emergency department is not necessary; this is especially true if you have video laryngoscopy and a bougie.
Source
First Attempt Success with Continued versus Paused Chest Compressions During Cardiac Arrest in the Emergency Department. Resuscitation. 2023 Feb 8;109726. doi: 10.1016/j.resuscitation.2023.109726. Online ahead of print.
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Through the use of point-of-care ultrasound (POCUS) Emergency Medicine providers can optimize and tailor pre-intubation resuscitation in critically ill patients. See algorithm below.
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This randomized, non-inferiority trial found that remifentanil plus hypnotics were inferior to neuromuscular blocking agents plus hypnotics for rapid sequence intubation of patients at risk of aspiration in the operating room setting.
Source
Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration: A Randomized Clinical Trial. JAMA. 2023 Jan 3;329(1):28-38. doi: 10.1001/jama.2022.23550.
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In patients presenting with angioedema, history of hypertension, shortness of breath, drooling, and anterior tongue or pharyngeal swelling were risk factors predicting eventual need for intubation.
Source
Clinical predictors of endotracheal intubation in patients presenting to the emergency department with angioedema. Am J Emerg Med. 2023 Jan;63:44-49. doi: 10.1016/j.ajem.2022.10.017. Epub 2022 Oct 19.
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Anesthesia residents with little experience in fiber-optic intubation achieved competency faster when trained with a high-fidelity versus low-fidelity model.
Source
Achieving Competency in Fiber-Optic Intubation Among Resident Physicians After Higher- Versus Lower-Fidelity Task Training: A Randomized Controlled Study. Anesth Analg. 2022 Nov 29. doi: 10.1213/ANE.0000000000006283. Online ahead of print.
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Ultrasonography can assist in identification of cricothyroid membrane for scalpel cricothyroidotomy pre-planning but should not be used in completion of the procedure itself.
Source
Role of ultrasonography in an impalpable tissue larynx model during a simulated front-of-neck access scenario: a randomized simulation study. CJEM. 2022 Nov 8. doi: 10.1007/s43678-022-00399-6. Epub ahead of print.
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Previously, first-attempt success rates for pediatric intubations hovered around 50%. Video-assisted laryngoscopy significantly increased first-attempt success rates and also had fewer adverse outcomes.
Source
Video-Assisted Laryngoscopy for Pediatric Tracheal Intubation in the Emergency Department: A Multicenter Study of Clinical Outcomes. Ann Emerg Med. 2022 Oct 15:S0196-0644(22)00604-7. doi: 10.1016/j.annemergmed.2022.08.021. Epub ahead of print.
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This study showed no difference in post-intubation hypotension for endotracheal intubations in the ED between ketamine and etomidate.
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In this single center cohort of 886 patients, 5 patients had definite awareness during paralysis. However, there were 61 patients determined to have possible awareness, meaning upwards of 7.4% of patients could have been aware.
Source
Recall of awareness during paralysis among emergency department patients undergoing tracheal intubation. Chest. 2022 Sep 08. Doi: https://doi.org/10.1016/j.chest.2022.08.2232
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There was an association with increased first attempt intubation success during direct laryngoscopy when using a Macintosh 3 laryngoscope blade compared to a Macintosh 4 blade.
Source
Impact of Macintosh blade size on endotracheal intubation success in intensive care units: a retrospective multicenter observational MacSize-ICU study. Intensive Care Medicine. August 16, 2022. Doi: 10.1007/s00134-022-06832-9
