Emergency Airway Management in Japan: a Multi-center Prospective Observational Study

Emergency Airway Management in Japan: a Multi-center Prospective

Observational Study

Hasegawa K, M.D.; Hagiwara Y, M.D, M.P.H.; Chiba T, M.D.; Watase H, M.D.; Walls MR, M.D.; Brown III CA, M.D;

Brown DFM, M.D.on behalf of the JEMRA investigators

Conflict of InterestFunding

There are no conflicts to declare.

Funding– St. Luke’s Life Science Institute Grant (Hasegawa)– Harvard Affiliated Emergency Medicine Residency

(Hasegawa)

BACKGROUND

• Emergency medicine is increasingly recognized as a medical specialty in Japan,

• Comprehensive studies evaluating emergency airway management practice are lacking.

OBJECTIVES

To describe – emergency intubation indications– methods used to intubate– success rates– adverse event rates

METHODSStudy Design

• a prospective observational multi-center data registry– with all data collection planned a priori

• IRB of each center has approved the protocol, with waiver for informed consent.

Study Setting

• the Japanese Emergency Airway Network (JEAN)– a consortium of 10 academic & community ED

• 9 affiliated with EM residency• Level I (n=9) or Level II equivalent (n=1) trauma

• an average ED census of 27,000 patient visits/y– range, 9,000 to 42,000

Selection of Participants

• Eligible for inclusion:– All patients who presented to 10 EDs and– Underwent endotracheal intubation

• Gathered prospectively during an 11-month period – April 2010 to February 2011

Measurements

• We report information about the distribution of:1. Indications for intubation.2. Methods used to intubate.3. Success rate of intubation by method.4. Adverse event rates

Using simple descriptive statistics.

RESULTS

• For the 11-month pilot period,

• 1,490 eligible patients.

• Database recorded 1,486 intubations (compliance rate 99.7%).

Principal Indication for Intubation

Initial Method of Airway Management

Success for Initial Method

DISCUSSIONpractice variations

• We are struck by a high degree of variations in airway management practices among sites.

• Because of the non-controlled nature of this study, the reasons for this variation are not well defined.– Confounding by indication?– Physician’s preference?

Variations in Success

The variability in the method of intubation may, in part, account for this variation

Potentially confounded by unmeasured variables

Assuming validities of our observations, this study hints at the need for efforts toimprove ED airway management quality.

LIMITATIONS

• Reporting bias• Outcomes not measured• Unmeasured confounders• External validity

CONCLUSIONS

• a high overall intubation success rate• a high degree of variations among hospitals in

emergency airway management.

• Our study provides a starting point to improve the quality of airway management.

ACKNOWLEDGEMENTThe authors acknowledge the following research personnel at the study sites: • Fukui University Hospital (Hideya Nagai, MD, Hiroshi Morita MD)• Fukui Prefectural Hospital (Yukinori Kato, MD, Hidenori Higashi, MD)• Japanese Red Cross Medical Center of Wakayama (Hiroshi Okamoto, MD)• Kameda Medical Center (Kenzo Tanaka, MD)• National Center for Global Health and Medicine (Taigo Sakamoto, MD, Shunichiro Nakao,

MD) • Nagoya Ekisaikai Hospital (Shigeki Tsuboi, MD)• Nigata City General Hospital (Nobuhiro Sato, MD)• Obama Municipal Hospital (Takuyo Chiba, MD)• Okinawa Chubu Prefectural Hospital (Masashi Okubo,MD)• Osaka Saiseikai Senri Hospital (Kazuaki Shigemitsu, MD, Shuho Sato, MD)

We are grateful to our many emergency physicians and residents for their perseverance in pursuing new knowledge about this vital resuscitative procedure

Intubator Demographics