title: Increased incidence of hypotension in elderly patients who underwent emergency airway management: an analysis of a multi-centre prospective observational study.
abstract: BACKGROUND
  Although the number of elderly increases disproportionately throughout the industrialised nations and intubation-related cardiovascular compromise is associated with hospital mortality, no emergency medicine literature has reported the direction and magnitude of effect of advanced age on post-intubation hypotension. We seek to determine whether advanced age is associated with an increased rate of hypotension at airway management in emergency departments (EDs).
  
  
  METHODS
  We conducted an analysis of a multi-centre prospective observational study of 13 Japanese EDs from April 2010 to March 2012. Inclusion criteria were all adult non-cardiac-arrest patients who underwent emergency intubation. We excluded patients in whom airway management was performed for shock or status asthmaticus as the principal indication. Patients were divided into two groups defined a priori: age ≥ 65 years old (elderly group) and age < 65 years old (younger group). The primary outcome measure was post-intubation hypotension in the ED.
  
  
  RESULTS
  During the 24-month period, 4,043 subjects required emergency airway management at 13 EDs. Among these, the database recorded 3,872 intubations (capture rate 96%). Of 1,903 eligible patients, 975 patients were age ≥ 65 years (51%) and 928 patients were age < 65 years (49%). The elderly group had a significantly higher rate of post-intubation hypotension compared with the younger group [3% vs. 1%; unadjusted OR 2.7 (95% CI, 1.3-5.6); P = 0.005]. In a model controlling for potential confounders (sex, principal indication, method, medication used to intubate, multiple intubation attempts), advanced age had an adjusted OR for post-intubation hypotension of 2.6 (95% CI, 1.3-5.6; P = 0.01).
  
  
  CONCLUSIONS
  In this large multi-centre study of ED patients who underwent emergent airway management, we found that elderly patients have a significantly higher risk of post-intubation hypotension. These data provide implications for the education and practice of ED airway management that may lead to better clinical outcomes and improved patient safety.
authors.affiliation: Departments of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA, 02114, USA.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hagiwara
authors.affiliation: Department of Emergency Medicine, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Imamura
authors.affiliation: Department of Emergency Medicine, Obama Municipal Hospital, Obama, Japan.
authors.forename: Takuyo
authors.initials: T
authors.lastname: Chiba
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, USA.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Watase
authors.affiliation: Departments of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.
authors.forename: Calvin A
authors.initials: CA
authors.lastname: Brown
authors.affiliation: Departments of Emergency Medicine, Massachusetts General Hospital, Boston, USA.
authors.forename: David Fm
authors.initials: DF
authors.lastname: Brown
keywords: Adverse events; Airway management; Elderly; Emergency department; Hypotension