title: Emergency airway management in Japan: Interim analysis of a multi-center prospective observational study.
abstract: OBJECTIVE
  Emergency medicine is increasingly recognized as a medical specialty in Japan. However, comprehensive studies evaluating emergency airway management practice are lacking. We describe emergency department (ED) airway management using a large multi-center registry.
  
  
  METHODS
  We formed the Japanese Emergency Airway Network, a consortium of 10 academic and community medical centers in Japan, and prospectively collected data on ED intubations from April 2010 to February 2011. All patients undergoing emergency intubation were eligible for inclusion. Data were entered in real time by the intubator using a standardized data form. Variables included patient's age, sex, weight, indication for intubation, methods of intubation, drugs, level of training and specialty of the intubator, number of attempts, success or failure, and adverse events. We present descriptive data as proportions with 95% confidence intervals.
  
  
  RESULTS
  We recorded 1486 intubations (compliance rate 99%). Intubation was ultimately successful in 99.7%. The initial method of intubation varied substantially among the hospitals, including rapid sequence intubation (0-79%), sedation without paralysis (4-88%), paralysis without sedation (0-18%), and oral without medication (12-67%), in non-cardiac arrest encounters. Success rates in first and ≤3 attempts ranged from 40 to 83% and from 74 to 100%, respectively. The overall adverse event rate was 11%, without significant difference by the method used.
  
  
  CONCLUSIONS
  In this multi-center study characterizing ED airway management across Japan, we observed a high overall success rate but a high degree of variation among hospitals in the methods of intubation and success rates.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. khasegawa1@partners.org
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hagiwara
authors.forename: Takuyo
authors.initials: T
authors.lastname: Chiba
authors.forename: Hiroko
authors.initials: H
authors.lastname: Watase
authors.forename: Ron M
authors.initials: RM
authors.lastname: Walls
authors.forename: David F M
authors.initials: DF
authors.lastname: Brown
authors.forename: Calvin A
authors.initials: CA
authors.lastname: Brown
mesh_terms: D000046:Academic Medical Centers; D058109:Airway Management / Q000379:methods; D000402:Airway Obstruction / Q000628:therapy*; D016208:Databases, Factual; D004635:Emergency Medicine / Q000592:standards / Q000639:trends; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007564:Japan; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D018570:Risk Assessment; D017751:Safety Management; D017749:Total Quality Management; D016896:Treatment Outcome