title: Feasibility of  upright patient positioning and intubation success rates At two academic EDs.
abstract: OBJECTIVE
  Endotracheal intubation is most commonly taught and performed in the supine position. Recent literature suggests that elevating the patient's head to a more upright position may decrease peri-intubation complications. However, there is little data on the feasibility of upright intubation in the emergency department. The goal of this study was to measure the success rate of emergency medicine residents performing intubation in supine and non-supine, including upright positions.
  
  
  METHODS
  This was a prospective observational study. Residents performing intubation recorded the angle of the head of the bed. The number of attempts required for successful intubation was recorded by faculty and espiratory therapists. The primary outcome of first past success was calculated with respect to three groups: 0-10° (supine), 11-44° (inclined), and ≥45° (upright); first past success was also analyzed in 5 degree angle increments.
  
  
  RESULTS
  A total of 231 intubations performed by 58 residents were analyzed. First pass success was 65.8% for the supine group, 77.9% for the inclined group, and 85.6% for the upright group (p=0.024). For every 5 degree increase in angle, there was increased likelihood of first pass success (AOR=1.11; 95% CI=1.01-1.22, p=0.043).
  
  
  CONCLUSIONS
  In our study emergency medicine residents had a high rate of success intubating in the upright position. While this does not demonstrate causation, it correlates with recent literature challenging the traditional supine approach to intubation and indicates that further investigation into optimal positioning during emergency department intubations is warranted.
authors.affiliation: Indiana University School of Medicine, Department of Emergency Medicine, United States. Electronic address: turnjose@iu.edu.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Turner
authors.affiliation: Indiana University School of Medicine, Department of Emergency Medicine, United States. Electronic address: tellende@iu.edu.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Ellender
authors.affiliation: Indiana University School of Medicine, Department of Emergency Medicine, United States; Carolinas Medical Center Emergency Medicine Residency, United States. Electronic address: Enola.okonkwo@gmail.com.
authors.forename: Enola R
authors.initials: ER
authors.lastname: Okonkwo
authors.affiliation: Indiana University School of Medicine, Department of Emergency Medicine, United States. Electronic address: tstepsis@iu.edu.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Stepsis
authors.affiliation: Indiana University School of Medicine, Department of Emergency Medicine, United States; Allina Health, United States. Electronic address: Andrew.stevens@allina.com.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Stevens
authors.affiliation: Indiana University School of Medicine, Department of Emergency Medicine, United States; Southern Illinois University Emergency Medicine Residency, United States. Electronic address: SembroskE@gmail.com.
authors.forename: Erik G
authors.initials: EG
authors.lastname: Sembroski
authors.affiliation: Indiana University School of Medicine, Department of Anesthesia, United States. Electronic address: ceddy@iupui.edu.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Eddy
authors.affiliation: Indiana University Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, United States. Electronic address: antperki@iupui.edu.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Perkins
authors.affiliation: Indiana University School of Medicine, Department of Emergency Medicine, United States. Electronic address: ddcooper@iu.edu.
authors.forename: Dylan D
authors.initials: DD
authors.lastname: Cooper
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007196:Indiana; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011446:Prospective Studies
keywords: Intubation; Laryngoscopy; Upright