title: Trauma airway management in emergency departments: a multicentre, prospective, observational study in Japan.
abstract: OBJECTIVE
  Although successful airway management is essential for emergency trauma care, comprehensive studies are limited. We sought to characterise current trauma care practice of airway management in the emergency departments (EDs) in Japan.
  
  
  METHODS
  Analysis of data from a prospective, observational, multicentre registry-the Japanese Emergency Airway Network (JEAN) registry.
  
  
  METHODS
  13 academic and community EDs from different geographic regions across Japan.
  
  
  METHODS
  723 trauma patients who underwent emergency intubation from March 2010 through August 2012.
  
  
  METHODS
  ED characteristics, patient and operator demographics, methods of airway management, intubation success or failure at each attempt and adverse events.
  
  
  RESULTS
  A total of 723 trauma patients who underwent emergency intubation were eligible for the analysis. Traumatic cardiac arrest comprised 32.6% (95% CI 29.3% to 36.1%) of patients. Rapid sequence intubation (RSI) was the initial method chosen in 23.9% (95% CI 21.0% to 27.2%) of all trauma patients and in 35.5% (95% CI 31.4% to 39.9%) of patients without cardiac arrest. Overall, intubation was successful in ≤3 attempts in 96% of patients (95% CI 94.3% to 97.2%). There was a wide variation in the initial methods of intubation; RSI as the initial method was performed in 0-50.9% of all trauma patients among 12 EDs. Similarly, there was a wide variation in success rates and adverse event rates across the EDs. Success rates varied between 35.5% and 90.5% at the first attempt, and 85.1% and 100% within three attempts across the 12 EDs.
  
  
  CONCLUSIONS
  In this multicentre prospective study in Japan, we observed a high overall success rate in airway management during trauma care. However, the methods of intubation and success rates were highly variable among hospitals.
authors: Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan.
authors: Shunichiro
authors: S
authors: Nakao
authors: Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan.
authors: Akio
authors: A
authors: Kimura
authors: Department of Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
authors: Yusuke
authors: Y
authors: Hagiwara
authors: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors: Kohei
authors: K
authors: Hasegawa
mesh_terms: D000328:Adult; D000368:Aged; D058109:Airway Management / Q000379:methods*; D019468:Disease Management; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000628:therapy; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007564:Japan; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012120:Respiration Disorders / Q000209:etiology / Q000628:therapy*
keywords: ACCIDENT & EMERGENCY MEDICINE; MEDICAL EDUCATION & TRAINING; TRAUMA MANAGEMENT
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