Utilization of intubation kits and checklist to improve first-pass success and reduce complications associated with endotracheal intubation in Rwanda.

INTRODUCTION

Sub-Saharan African countries experience high mortality rates from respiratory failure, with limited emergency medicine training and resources contributing to poor outcomes. While endotracheal intubation (ETI) is a critical emergency procedure, multiple intubation attempts are associated with severe complications. Data on intubation outcomes in Sub-Saharan Africa is scarce, existing research suggests high complication and mortality rates, with mixed results regarding efficacy of pre intubation checklists. This study aims to evaluate the effectiveness of pre-assembled ETI kits and checklists in improving first-pass ETI success rates and reducing complications in the emergency department at University Teaching Hospital - Kigali, Rwanda (CHUK).

METHODS

This six-month pre-post quality improvement study at the CHUK emergency department includes consenting participants 16 years or older requiring ETI. Data on patient demographics, intubation success, and complications was collected using a standardized form three months before and after implementation of intubation kits and checklists.

RESULTS

A total of 135 intubations were analyzed from May to October 2024. First-pass success did not differ between pre-post groups (OR 1.24, 95% CI 0.41-3.68, p = 0.93). Rates of peri intubation complications were unchanged following implementation (OR 0.65, 95% CI 0.44-2.18, p = 0.94). Post-intubation complications occurred had fewer occurrences after intervention however, this was not a statistically significant difference.

DISCUSSION: Implementation of pre-assembled ETI kits with a standardized checklist did not significantly improve first-pass success or overall complications. However, the trend toward fewer post-intubation adverse events indicates a possible benefit that may have been underpowered to detect. These results underscore the importance of a larger study to clarify the impact of structured airway management in low resource settings.