![]() The percentage of patients with first pass success without an adverse event increased from 64.0% to 80.9% (difference = 16.9%, 95% CI 10.6% to 23.1%).Ĭonclusion: The use of an airway CQI program with an ongoing airway registry resulted in a substantial improvement in the overall safety of RSI in the ED as evidenced by an increase in first pass success and a decrease in adverse events. The percentage of patients who experienced an adverse event associated with intubation decreased from 22.5% to 14.4% (difference = -7.9%, 95% CI -13.4% to -2.4%). Over the 10-year study period, first pass success increased from 73.1% to 92.4% (difference = 19.3%, 95% CI 14.0% to 24.6%). We recommend that clinicians who are trained in tracheal intubation use RSI for most children who require emergency intubation. Rapid sequence intubation (RSI) traditionally involves the sequential administration of a sedative and neuromuscular blocking agent. ![]() Results: EM residents performed RSI on 342 adult patients during Academic Year 1 and on 445 adult patients during Academic Year 10. Data were analyzed by academic year and are reported descriptively with 95% confidence intervals (CI) of the difference of means. ![]() Educational and clinical interventions were introduced throughout the study period with the goal of optimizing these outcomes. The secondary outcome was the prevalence of adverse events associated with intubation. The primary outcome was first pass success which was defined as successful tracheal intubation with a single laryngoscope insertion. Adult patients who underwent RSI in the ED with an initial intubation attempt by emergency medicine (EM) resident were included in the analysis. Key data points included method of intubation, drugs and devices used for intubation, operator specialty and level of training, number of intubation attempts, and adverse events. Data were prospectively collected on all patients intubated in the ED during this period using a structured airway data collection form. Methods: An airway CQI program with an ongoing airway registry was initiated in our ED on J(Academic Year 1) and continued through J(Academic Year 10). The purpose of this investigation is to describe an airway continuous quality improvement (CQI) program and its effect on the safety of rapid sequence intubation (RSI) in the emergency department (ED) over a 10-year period. Introduction: Airway management in the critically ill is associated with a high prevalence of failed first attempts and adverse events which negatively impacts patient care.
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