title: Repeated attempts at tracheal intubation by a single intubator associated with decreased success rates in emergency departments: an analysis of a multicentre prospective observational study.
abstract: OBJECTIVE
  To determine whether the success rate of repeated attempts at tracheal intubation by a single intubator was lower than those by alternate intubators in the emergency department (ED).
  
  
  METHODS
  An analysis of data from a multicentre prospective registry (Japanese Emergency Airway Network Registry) of 13 academic and community EDs in Japan between April 2010 and August 2012. We included all adult and paediatric patients who underwent repeated attempts at tracheal intubation in the ED. We compared the intubation success rates at the second and third attempts between attempts at intubation by a single intubator who performed the previous attempts, and the attempts by alternate intubators.
  
  
  RESULTS
  We recorded 4094 patients (capture rate, 96%); 1289 patients with repeated attempts at tracheal intubation were eligible for this study. Among these, 871 patients (68%) had a second attempt at intubation by single intubators. At the second attempt, tracheal intubation by a single intubator was associated with a decreased success rate (adjusted odds ratio or AOR, 0.50; 95% CI 0.36 to 0.71), compared with alternate intubators. At the third attempt, intubation by a single intubator was also associated with a decreased success rate (58% vs 70%; unadjusted OR, 0.58; 95% CI 0.38 to 0.89). However, after adjustment for potential confounders, the association lost statistical significance (AOR, 0.89; 95% CI 0.52 to 1.56).
  
  
  CONCLUSIONS
  In this large multicentre study of ED patients undergoing tracheal intubation, second attempts at intubation by a single intubator, compared with those by alternate intubators, were independently associated with a decreased success rate.
authors.affiliation: Department of Emergency Medicine, University of Fukui Hospital Fukui, Japan Senri Critical Care Medical Centre, Osaka Saiseikai Senri Hospital, Suita, Japan.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Goto
authors.affiliation: Japanese Emergency Medicine Network, Seattle, Washington, USA.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Watase
authors.affiliation: Department of Emergency Medicine, University of Fukui Hospital Fukui, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morita
authors.affiliation: Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan.
authors.forename: Hideya
authors.initials: H
authors.lastname: Nagai
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Calvin A
authors.initials: CA
authors.lastname: Brown
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: David F M
authors.initials: DF
authors.lastname: Brown
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D017211:Treatment Failure; D055815:Young Adult