Out-of-theatre tracheal intubation: prospective multicentre study of clinical practice and adverse events

• Published in: British journal of anaesthesia : BJA Vol. 107; no. 5; pp. 687 - 692
• Main Authors: Bowles, T.M., Freshwater-Turner, D.A., Janssen, D.J., Peden, C.J.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.11.2011; Oxford University Press
• Subjects: airway management; Airway Management - methods; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Capnography; Critical Care; Emergency Medical Services - methods; Emergency Service, Hospital; Hospital Mortality; Hospitals - statistics & numerical data; Humans; Hypnotics and Sedatives - administration & dosage; intubation, intratracheal; Intubation, Intratracheal - methods; Medical sciences; Neuromuscular Blocking Agents - administration & dosage; practice guidelines; Practice Guidelines as Topic; Propofol - administration & dosage; Prospective Studies; Respiratory Insufficiency - therapy; United Kingdom; practice guidelines; airway management; intubation, intratracheal; capnography; Clinical management; Capnography; intratracheal; Anesthesia; Complication; Intubation
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aer251

Tracheal intubation is commonly performed outside the operating theatre and is associated with higher risk than intubation in theatre. Recent guidelines and publications including the 4th National Audit Project of the Royal College of Anaesthetists have sought to improve the safety of out-of-theatre intubations. We performed a prospective observational study examining all tracheal intubations occurring outside the operating theatre in nine hospitals over a 1 month period. Data were collected on speciality and grade of intubator, presence of essential safety equipment and monitoring, and adverse events. One hundred and sixty-four out-of-theatre intubations were identified (excluding those where intubation occurred as part of the management of cardiac arrest). The most common indication for intubation was respiratory failure [74 cases (45%)]. Doctors with at least 6 month's experience in anaesthesia performed 136 intubations (83%); consultants were present for 68 cases (41%), and overall a second intubator was present for 94 procedures (57%). Propofol was the most common induction agent [124 cases (76%)] and 157 patients (96%) received neuromuscular blocking agents. An airway rescue device was available in 139 cases (87%). Capnography was not used in 52 cases (32%). Sixty-four patients suffered at least one adverse event (39%) around the time of tracheal intubation. Out-of-theatre intubation frequently occurs in the absence of essential safety equipment, despite the existing guidelines. The associated adverse event rate is high.