Intubation first-pass success in a high performing pre-hospital critical care system is not associated with 30-day mortality: a registry study of 4496 intubation attempts

Harry Ljungqvist, Jussi Pirneskoski, Anssi Saviluoto, Piritta Setälä, Miretta Tommila, Jouni Nurmi

    Research output: Contribution to journalArticleScientificpeer-review

    6 Citations (Scopus)
    6 Downloads (Pure)

    Abstract

    Background: Lower intubation first-pass success (FPS) rate is associated with physiological deterioration, and FPS is widely used as a quality indicator of the airway management of a critically ill patient. However, data on FPS’s association with survival is limited. We aimed to investigate if the FPS rate is associated with 30-day mortality or physiological complications in a pre-hospital setting. Furthermore, we wanted to describe the FPS rate in Finnish helicopter emergency medical services. Methods: This was a retrospective observational study. Data on drug-facilitated intubation attempts by helicopter emergency medical services were gathered from a national database and analysed. Multivariate logistic regression, including known prognostic factors, was performed to assess the association between FPS and 30-day mortality, collected from population registry data. Results: Of 4496 intubation attempts, 4082 (91%) succeeded on the first attempt. The mortality rates in FPS and non-FPS patients were 34% and 38% (P = 0.21), respectively. The adjusted odds ratio of FPS for 30-day mortality was 0.88 (95% CI 0.66–1.16). Hypoxia after intubation and at the time of handover was more frequent in the non-FPS group (12% vs. 5%, P < 0.001, and 5% vs. 3%, P = 0.01, respectively), but no significant differences were observed regarding other complications. Conclusion: FPS is not associated with 30-day mortality in pre-hospital critical care delivered by advanced providers. It should therefore be seen more as a process quality indicator instead of a risk factor of poor outcome, at least considering the current limitations of the parameter.

    Original languageEnglish
    Article number61
    Number of pages7
    JournalScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
    Volume30
    Issue number1
    DOIs
    Publication statusPublished - 2022
    Publication typeA1 Journal article-refereed

    Keywords

    • Air ambulances
    • Airway management
    • Critical care
    • Emergency medical services
    • First-pass success
    • Rapid sequence induction and intubation

    Publication forum classification

    • Publication forum level 1

    ASJC Scopus subject areas

    • Emergency Medicine
    • Critical Care and Intensive Care Medicine

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