title: Trainee experience and success of urgent airway management.
abstract: BACKGROUND
  There are limited data regarding emergent, non-operating room, intubations performed by all levels of anesthesia residents. This study was a large retrospective review of all non-operating room emergent intubations performed at a single tertiary medical center. The study evaluated the rate of difficult intubations by level of resident training, compared success rates for direct versus video laryngoscopy and evaluated the rate and success of rescue video laryngoscopy following failed direct laryngoscopy.
  
  
  METHODS
  All emergent non-operating room intubations at a tertiary university medical center from July 1, 2009, to August 1, 2012, were reviewed and all study data were collected from the medical records. Intubations were classified as being initiated with either direct or video methods. The total number of attempts required and the rate of success were compared by resident year and intubation type.
  
  
  RESULTS
  Out of a total of 788 emergent intubations, 741 were performed by anesthesia residents. The higher level anesthesia residents (CA-2 and CA-3) had a statistically significant decrease in the number of attempts needed when compared to CA-1 residents. Rate of success did not vary by resident training year, but success rates were higher for cases initiated with video laryngoscopy. Among direct initiated cases, 8% failed initial direct laryngoscopy and were then successfully intubated with rescue video laryngoscopy.
  
  
  CONCLUSIONS
  During emergent, non-operating room intubations, senior level residents used fewer attempts at intubations with direct laryngoscopy. Successful intubation was improved by beginning residents when video laryngoscopy was utilized. Complications were not affected by the presence of the attending anesthesiologist.
authors.affiliation: University of Nebraska Medical Center Department of Anesthesiology, Omaha, NE. Electronic address: teschult@unmc.edu.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Schulte
authors.affiliation: University of Nebraska Medical Center Department of Anesthesiology, Omaha, NE.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Ringenberg
authors.affiliation: University of Nebraska Medical Center Department of Anesthesiology, Omaha, NE.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lisco
authors.affiliation: University of Nebraska Medical Center Dept. of Biostatistics, Omaha, NE.
authors.forename: Harlan
authors.initials: H
authors.lastname: Sayles
authors.affiliation: University of Nebraska Medical Center Department of Anesthesiology, Omaha, NE.
authors.forename: Sasha K
authors.initials: SK
authors.lastname: Shillcutt
mesh_terms: D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014741:Video Recording