Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey.
BACKGROUND
Respiratory failure is a common problem in emergency medicine (EM) and critical care medicine (CCM). However, little is known about the resuscitation of critically ill patients prior to emergency endotracheal intubation (EETI). Our aim was to describe the resuscitation practices of EM and CCM physicians prior to EETI.


METHODS
A cross-sectional survey was developed and tested for content validity and retest reliability by members of the Canadian Critical Care Trials Group. The questionnaire was distributed to all EM and CCM physician members of three national organizations. Using three clinical scenarios (trauma, pneumonia, congestive heart failure), we assessed physician preferences for use and types of fluid and vasopressor medication in pre-EETI resuscitation of critically ill patients.


RESULTS
In total, 1,758 physicians were surveyed (response rate 50.2%, 882/1,758). Overall, physicians would perform pre-EETI resuscitation using either fluids or vasopressors in 54% (1,193/2,203) of cases. Most physicians would "always/often" administer intravenous fluid pre-EETI in the three clinical scenarios (81%, 1,484/1,830). Crystalloids were the most common fluid physicians would "always/often" administer in congestive heart failure (EM 43%; CCM 44%), pneumonia (EM 97%; CCM 95%) and trauma (EM 96%; CCM 96%). Pre-EETI resuscitation using vasopressors was uncommon (4.9%). Training in CCM was associated with performing pre-EETI resuscitation (odds ratio, 2.20; 95% CI, [1.44-3.36], p<0.001).


CONCLUSIONS
Pre-EETI resuscitation is common among Canadian EM and CCM physicians. Most physicians use crystalloids pre-EETI as a resuscitation fluid, while few would give vasopressors. Physicians with CCM training were more likely to perform pre-EETI resuscitation.
Dalhousie University, Department of Critical Care, Halifax, Nova Scotia, Canada; Trauma Nova Scotia, Halifax, Nova Scotia, Canada.
Robert S
RS
Green
University of Ottawa, Department of Medicine, Division of Clinical Epidemiology, Ottawa, Ontario, Canada; University of Ottawa, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.
Dean A
DA
Fergusson
Université Laval, CHU de Quebec Research Center, Hôpital de l'Enfant-Jesus, Population Health and Optimal Health Practices Unit, Trauma-Emergency-Critical Care Medicine Group, Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Quebec City, Quebec, Canada.
Alexis F
AF
Turgeon
University of Ottawa, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; University of Ottawa, Department of Medicine, Division of Critical Care Medicine, Ottawa, Ontario, Canada.
Lauralyn A
LA
McIntyre
Dalhousie University, Department of Emergency Medicine, Halifax, Nova Scotia, Canada.
George J
GJ
Kovacs
University of British Columbia, Department of Anesthesia, Pharmacology and Therapeutics, Vancouver, Department of Medicine, Division of Critical Care, Vancouver, British Columbia, Canada; Vancouver Coastal Health Research Institute, Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada.
Donald E
DE
Griesdale
CancerCare Manitoba, Department of Haematology and Medical Oncology, Winnipeg, Manitoba, Canada; University of Manitoba, Winnipeg Regional Health Authority, George & Fay Yee Center for Healthcare Innovation, Department of Internal Medicine, Winnipeg, Manitoba, Canada.
Ryan
R
Zarychanski
Dalhousie University, Department of Critical Care, Halifax, Nova Scotia, Canada.
Michael B
MB
Butler
Dalhousie University, Department of Critical Care, Halifax, Nova Scotia, Canada.
Nelofar
N
Kureshi
Trauma Nova Scotia, Halifax, Nova Scotia, Canada.
Mete
M
Erdogan
D002170:Canada; D003422:Critical Care; D016638:Critical Illness; D003430:Cross-Sectional Studies; D000077324:Crystalloid Solutions; D004635:Emergency Medicine; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007552:Isotonic Solutions / Q000008:administration & dosage; D010820:Physicians; D015203:Reproducibility of Results; D012151:Resuscitation / Q000379:methods*; D011795:Surveys and Questionnaires
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions