title: Factors associated with successful second and third intubation attempts in the ED.
abstract: OBJECTIVE
  The aim of this study was to identify the factors associated with successful second and third attempts in adults following a failed first intubation attempt in the emergency department (ED).
  
  
  METHODS
  This was a retrospective analysis of the data from a multicenter, prospective, observational airway registry in South Korea. We obtained demographic and clinical data of intubated adult patients in 6 academic EDs from January 2007 to December 2010. The primary outcome was successful rescue attempt, which was defined as the successful placement of an endotracheal tube following a failed first intubation attempt. Logistic regression analyses were conducted to develop a multivariate model identifying factors associated with successful second and third attempts.
  
  
  RESULTS
  Of 5905 adult patients, 1122 (19.0%) failed a first intubation attempt. The success rates of the second and third attempts were 79.2% and 78.5%, respectively. In the multivariate logistic regression analysis, factors associated with a successful second attempt were emergency physicians, senior physicians, nondifficult airway, and the use of a rapid sequence intubation (RSI) (odds ratio = 2.81 [95% confidence interval, 1.80-4.37], 1.50 [1.10-2.07], 2.15 [1.53-3.01], and 1.53 [1.01-2.33], respectively). Nondifficult airway and the use of RSI were associated with successful third attempts (5.48 [2.69-11.18] and 2.63 [1.08-6.40], respectively).
  
  
  CONCLUSIONS
  Nondifficult airway and the use of RSI were associated with successful second and third intubation attempts. The use of RSI, backup by experienced senior physicians, and preparation for management of a difficult airway could be strategies for successful rescue intubation attempts in the ED.
authors.affiliation: Department of Emergency Medicine, School of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Kim
authors.forename: Hyuk Joong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Sang Mo
authors.initials: SM
authors.lastname: Je
authors.forename: Euichung
authors.initials: E
authors.lastname: Kim
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure