Predictive Factors for First-Pass Intubation Failure in Trauma Patients

Abstract

Katherine Kilkenny,1 Shea McGrinder,1 Michael J Najac,2 Johnathon LeBaron,3 Pietro Carpenito,4 Nisha Lakhi1,5 1School of Medicine, New York Medical College, Valhalla, NY, USA; 2Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA; 3Department of Emergency Medicine, Richmond University Medical Center, Staten Island, NY, USA; 4Department of Anesthesiology, Richmond University Medical Center, Staten Island, NY, USA; 5Department of Trauma Surgery, Richmond University Medical Center, Staten Island, NY, USACorrespondence: Nisha Lakhi, Associate Professor of Obstetrics and Gynecology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY, 10310, USA, Email [email protected]: The primary objective of this study was to elucidate risk factors for multiple intubation attempts (MIA) in trauma patients requiring emergent tracheal intubation (ETI). Risk factors for mortality, intensive care unit (ICU) admission, and prolonged ventilation were assessed as secondary outcomes. The association between multiple intubation attempts and adverse outcomes has been well described in the literature. Though previous studies have identified anatomical risk factors for difficult airways, no study to date has investigated predictors for MIA in a trauma setting.Methods: The retrospective study involved 174 adult patients who required ETI and who presented to a Level 1 Trauma Center’s emergency department between January 2019 and December 2022. Comorbidities, demographic information, triage vitals, intubation characteristics, and patient outcomes were identified to ascertain predictive risk factors for MIA. Variables were assessed for statistical significance on unadjusted analysis. Significant variables were entered into multivariate logistic regression models to test for adjusted associations, with p≤ .0.05 as statistically significant, and presented as adjusted odds ratios with 95% confidence intervals.Results: Twenty-six (14.9%) of the 174 patients required multiple intubation attempts. There were no significant associations between MIA and patient gender, age, BMI, race, injury mechanism, or specific body region injuries. On univariate analysis, the MIA group had a statistically significant elevation in mean systolic blood pressure (151.71 ± 45.96 vs 133.55 ± 32.11, p = 0.019) and heart rate (106.30 ± 34.92 vs 93.35 ± 24.82, p < 0.032) compared to subjects with first-pass success. Elevation in systolic blood pressure (SBP) (151.71 ± 45.96 vs 133.55 ± 32.11, aOR 1.03 (1.01– 1.06), p < 0.015) was an independent predictor of multiple intubation attempts.Conclusion: Elevation in SBP was a significant predictor of multiple intubation attempts. Critical appraisal of patients requiring ETI with elevated SBP may mitigate risk in trauma settings.Keywords: trauma, multiple intubation attempts, first-pass intubation failure, emergency tracheal intubation, airway, adult, intubation trauma

Keywords

• trauma
• multiple intubation attempts
• first-pass intubation failure
• emergency tracheal intubation
• airway
• adult
• intubation trauma