Association between physician specialty and first-attempt intubation success in the emergency department.
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Oliveira J E Silva Lucas, Von Hellmann Rafael, Pinheiro Besen Bruno A M, de Carvalho Julia M Dorn, Hajjar Ludhmila Abrahao, Pedrollo Daniel, Goncalves Nogueira Caio, Figueiredo Natalia Mansur P, Miranda Carlos Henrique, Martins Danilo, Baumgratz Thiago Dias, Bergesch Bruno, Costa Diogo, Colleoni Osmar, Zanettini Juliana, Freitas Ana Paula, Moreira Nicole Pinheiro, Gaspar Patricia Lopes, Tambelli Renato, Costa Maria Cristina, Silveira Samara, Correia Wilsterman, de Maria Rafael Garcia, Vinholes Filho Ubirajara A, Weber Andre P, da Silva Castro Vinicius, Dornelles Carlos Fernando D, Tabach Barbara S, Guimarães Hélio P, Stanzani Gabriela, Gava Thiago F, Mullan Aidan, Alonso Silva Gabriel Petrin, de Oliveira Giovanna Cardoso, Sandefur Benjamin J, Bellolio Fernanda, Alencar Julio C G, Ward A Maia Ian, BARCO Investigators
Аннотация
OBJECTIVE: To assess the association of physician specialty with first-attempt success and immediate peri-intubation complications in Brazilian EDs.
DESIGN: Secondary analysis of a multicenter, prospective cohort study from the Brazilian Airway Registry Cooperation.
SETTING AND PARTICIPANTS: This study included adult patients who underwent tracheal intubation in EDs between March 2022 and April 2024. Patients were excluded if the intubation occurred outside the ED, during cardiopulmonary resuscitation, or for elective procedures. Intubations performed by medical students were also excluded. Physicians were categorized by specialty as emergency medicine or nonemergency medicine.
OUTCOME MEASURES AND ANALYSIS: The primary outcome was first-attempt success; secondary outcomes included peri-intubation complications (severe hypoxemia, hemodynamic instability, and cardiac arrest). Multivariable logistic regression was used to assess the association between physician specialty and outcomes.
MAIN RESULTS: Among 2582 patients, 1087 (42.1%) were intubated by emergency physicians and 1495 (57.9%) by other physicians (mainly internal medicine and surgery). Intubations by emergency physicians were associated with a higher rate of first-attempt success [80.4 vs. 70.9%, adjusted odds ratio [aOR]: 1.63, 95% confidence interval (CI): 1.34-1.97]. There was also a higher odds of intubations without major complications (aOR: 1.20, 95% CI: 1.01-1.42).
CONCLUSION: In this study, there was a higher rate of first-attempt success in intubations performed by board-certified emergency physicians compared with other physicians working in Brazilian EDs.