Analysis of the airway registry from an academic emergency department in South Africa

Abstract

Airway management is an essential skill for emergency physicians. Safety and efficacy are crucial components to the success thereof. Analysis of an airway registry can provide feedback that can be used for quality improvement purposes.

Objectives The aim of this study was to examine the first airway registry from an academic Emergency Department (ED) in South Africa, a low-middle income country (LMIC) in Africa, and compare the findings to international data.

Methods A retrospective analysis of 13 month’s data from the airway registry from an academic ED with annual census of 60 000 patients. Data analysed included demographics, indications for intubation, training level of operator, type of intubation device, number of attempts, pre-oxygenation methods as well as drug and intravenous fluids usage.

Results A total of 321 patient intubations were included. The majority of the patients had non-traumatic indications for intubation (71.6%). The overall first-pass intubation success rate was 76%, compared with international rates of 80-90%. This less than ideal rate was attributable to the lower first-pass success rates of junior operators (interns). The more experienced medical officers and registrars had similar success rates to international findings (83-85% and 82-91% respectively). Overall first-pass success rates showed no difference for video (81%) compared to direct (73%) laryngoscopy (p-value 0.079) although better glottic views were obtained with video laryngoscopy (80% were Cormack-Lehane Grade 1). Analysis of pre-oxygenation methods suggested that some patients desaturated more despite having received more aggressive pre-oxygenation e.g. with non-invasive (36% desaturated) or bag-mask ventilation (60% desaturated) techniques. It is postulated that these patients were sicker compared with those only pre-oxygenated with simple non-rebreather face-mask pre-oxygenation (only 4% desaturated).

Conclusion This analysis of the first airway registry from an academic ED in South Africa, highlights that airway management in an LMIC can be performed on par with accepted international standards. It serves as a good baseline for further research into airway management in other LMIC.