Indications, techniques, success rates and complications of emergency airway management in Thuringian emergency departments: a prospective registry analysis.

BACKGROUND: Airway management is a core competence in emergency medicine. International registries have described indications, techniques, and outcomes of endotracheal intubation, yet contemporary data from German emergency departments (EDs) are scarce. We conducted a multicenter prospective registry study in Thuringia, to characterize indications, techniques, success rates, and complications of ED intubations. METHODS: From February 2023 to January 2024, six Thuringian EDs participated in a prospective observational registry (www.airwayregistry.eu). All consecutive intubations were documented anonymously using a standardized digital form. Demographics, indications, methods, equipment, operator characteristics, first pass success (FPS), overall success, and complications were captured. Descriptive statistics were used. RESULTS: We analyzed 117 intubations (63.2% male; mean age 68.4 years, range 2-98 years). FPS was 88.9% (104/117), second pass success was 4.3% and third pass success was 6.8%; overall success was 100%. Rapid sequence intubation (RSI) was used in 77.8% of intubations and delayed sequence intubation (DSI) in 21.4%; 10.3% were performed without medication. Direct laryngoscopy (DL) was used in 65.0% and videolaryngoscopy (VL) in 34.2%. FPS was higher with VL than DL (92.5% vs. 88.2%). The most common indications were cardiopulmonary resuscitation (14.5%) and stroke/ischemia (13.7%); intracranial hemorrhage accounted for 13.7%. Complications occurred in 39% of cases, most frequently hypotension (23.9%) and catecholamine requirement (12.0%). A difficult airway was anticipated in 30.8%. CONCLUSION: In this multicenter snapshot from German EDs, overall intubation success was high but complications-especially peri-intubation hypotension-were common. VL yielded higher FPS yet was used less frequently than DL. Standardized protocols, hemodynamic optimization, and broader VL adoption may improve safety and performance.