Repeated Attempts at Intubation Are Associated with Adverse Events

Conventional wisdom is that first-pass success at intubation is good and that multiple attempts are associated with untoward events, yet no evidence links multiple intubation attempts with adverse events in an emergency department (ED) patient population.

In this analysis of a prospective registry of 2616 patients who required intubation in 11 Japanese EDs, 11% of patients required multiple laryngoscopic attempts (defined as ≥3). First attempts were performed by emergency physicians (including emergency medicine residents) in 48% of cases and by transitional-year residents (postgraduate year 1 or 2) in 40%.

The authors determined that multiple attempts were associated with an increased risk (adjusted odds ratio, 4.5) for intubation-related ad…