A comparison of trauma intubations managed by anesthesiologists and emergency physicians.
Although airway management by emergency physicians has become standard for general emergency department (ED) patients, many believe that anesthesiologists should manage the airways of trauma victims.


OBJECTIVE
To compare the success and failure rates of trauma intubations performed under the supervision of anesthesiologists and emergency physicians.


METHODS
This was a prospective, observational study of consecutive endotracheal intubations (ETIs) of adult trauma patients in a single ED over a 46-month period. All ETIs before November 26, 2000, were supervised by anesthesiologists (34 months), and all ETIs from November 26, 2000, onward were supervised by emergency physicians (12 months). Data regarding clinical presentation, personnel involved, medications used, number of attempts required, and need for cricothyrotomy were collected. Study outcomes were: 1) successful intubation within two attempts, and 2) failure of intubation. Failure was defined as inability to intubate, resulting in successful intubation by another specialist, or cricothyrotomy. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were used to compare results between groups.


RESULTS
There were 673 intubations during the study period. Intubation within two attempts was accomplished in 442 of 467 patients (94.6%) managed by anesthesiologists, and in 196 of 206 of patients (95.2%) managed by emergency physicians (OR = 1.109, 95% CI = 0.498 to 2.522). Failure of intubation occurred in 16 of 467 (3.4%) patients managed by anesthesiologists, and in four of 206 (1.9%) patients managed by emergency physicians (OR = 0.558, 95% CI = 0.156 to 1.806).


CONCLUSIONS
Emergency physicians can safely manage the airways of trauma patients. Success and failure rates are similar to those of anesthesiologists.
Bushra
Joseph S
JS
Department of Emergency Medicine, Temple University Hospital and School of Medicine, Philadelphia, PA 19140, USA. jsbushra@yahoo.com
McNeil
Bryon
B
Wald
David A
DA
Schwell
Ari
A
Karras
David J
DJ
D000328:Adult; D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy; D000776:Anesthesiology / Q000193:education / Q000592:standards*; D002983:Clinical Competence; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000193:education / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D014140:Tracheotomy / Q000706:statistics & numerical data; D014481:United States; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*