title: Techniques and outcomes of emergency airway management in Japan: An analysis of two multicentre prospective observational studies, 2010-2016.
abstract: Continuous surveillance of emergency airway management practice is imperative in improving quality of care and patient safety. We aimed to investigate the changes in the practice of emergency airway management and the related outcomes in the emergency departments (EDs) in Japan.
  
  
  
  We conducted an analysis of the data from two prospective, observational, multicentre registries of emergency airway management-the Japanese Emergency Airway Network (JEAN)-1 and -2 Registries from April 2010 through May 2016.
  
  
  
  We recorded 10,927 ED intubations (capture rate, 96%); 10,875 paediatric and adult patients were eligible for our analysis. The rate of rapid sequence intubation (RSI) use as the initial intubation method significantly increased from 28% in 2010 to 53% in 2016 (Ptrend=0.03). Likewise, the rate of video laryngoscope (VL) use as the first intubation device increased significantly from 2% in 2010 to 40% in 2016 (Ptrend<0.001), with a significant decrease in the rate of direct laryngoscope use from 97% in 2010 to 58% in 2016 (Ptrend<0.001). Concurrent with these changes, the overall first-attempt success rate also increased from 68% in 2010 to 74% in 2016 (Ptrend=0.02). By contrast, the rate of adverse events did not change significantly over time (Ptrend=0.06).
  
  
  
  By using data from two large, multicentre, prospective registries, we characterised the current emergency airway management practice, and identified their changes in Japan. The data demonstrated significant increases in the rate of RSI and VL use on the first attempt and the first-attempt success rate over the 6-year study period.
authors.affiliation: Department of Emergency Medicine, Nagoya Ekisaikai Hospital, 4-66 Shonen, Nakagawa, Nagoya, Aichi 454-8502, Japan. Electronic address: gotoyu@ekisai.or.jp.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Goto
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street Boston, Suite 920, Boston, MA 02114, USA.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Goto
authors.affiliation: Department of Paediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Centre, 2-8-29 Musashidai, Fuchu, Tokyo 183-8561, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hagiwara
authors.affiliation: Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue Boston, MA 02115, USA.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tsugawa
authors.affiliation: Department of Radiology, University of Washington, 850 Republican Street Seattle, WA 98006, USA.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Watase
authors.affiliation: Centre for Clinical Epidemiology, Department of Emergency Medicine, St. Luke's International Hospital, 3-6 Tsukiji, Chuo, Tokyo 104-0045, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okamoto
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street Boston, Suite 920, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004635:Emergency Medicine / Q000379:methods; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods* / Q000706:statistics & numerical data; D007564:Japan; D020704:Laryngoscopes / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
keywords: Emergency airway management; First-attempt success rate; Intubation