title: Airway management of adult patients without trauma in an ED led by internists.
abstract: BACKGROUND
  Airway management is a key competence in emergency medicine. Patients heavily differ from those in the operating room. They are acutely ill by definition and usually not fasting. Evaluation of risk factors is often impossible. Current literature primarily originates from countries where emergency medicine is an independent specialty. We evaluated intubations in a high-volume emergency department run by internists and comprising its own distinctive intensive care unit.
  
  
  METHODS
  In this prospective, noncontrolled, observational study, we continuously documented all intubations performed at the emergency department. We analyzed demographic, medical, and staff-related factors predicting difficulties during intubation using logistic regression models.
  
  
  RESULTS
  For 73 months, 660 cases were included, 69 (10.5%) of them were without any induction therapy. Two hundred fifty-two (38.2%) patients were female, and their mean age was 59 ± 17 years. Three hundred four (49.9%) had an initial Glasgow Coma Scale of 3. Leading indications were respiratory insufficiency (n = 246; 37.3%), resuscitation (n = 172; 26.1%), and intracranial hemorrhage (n = 75; 11.4%). First attempt was successful in 465 cases (75.1%); alternative airway devices were used in 22 cases (3.3%). Time from the first intubation attempt to a validated airway was 1 minute (interquartile range, 0-2 minutes). Physicians' experience and anatomical risk factors were associated with failure at the first attempt, prolonged intubation, and the need for alternative devices.
  
  
  CONCLUSIONS
  Airway management at the emergency department possesses a high potential of failure. Experience seems to be the key to success.
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Dominik
authors.initials: D
authors.lastname: Roth
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schreiber
authors.forename: Peter
authors.initials: P
authors.lastname: Stratil
authors.forename: Katharina
authors.initials: K
authors.lastname: Pichler
authors.forename: Christof
authors.initials: C
authors.lastname: Havel
authors.forename: Moritz
authors.initials: M
authors.lastname: Haugk
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000592:standards / Q000706:statistics & numerical data*; D002648:Child; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007388:Internal Medicine / Q000592:standards / Q000706:statistics & numerical data*; D007396:Internship and Residency / Q000592:standards / Q000706:statistics & numerical data; D020300:Intracranial Hemorrhages / Q000628:therapy; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000592:standards; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D000078329:Workforce; D055815:Young Adult