A Prospective Observational Study of Clinical Profile and Outcomes of Patients Undergoing Emergency Endotracheal Intubation in the Emergency Department
Authors
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
Objective: Emergency endotracheal intubation (ETI), a critical life-saving intervention in the emergency department (ED) is associated with significant complications and mortality. We aimed to evaluate clinical profile, procedural characteristics, complications, and outcomes of patients undergoing emergency endotracheal intubation in a tertiary care emergency department. Methods: This prospective observational study was conducted on 200 patients requiring ETI in the Department of Emergency Medicine. Demographic details, clinical presentation, indications for intubation, number of intubation attempts, immediate and late complications and final outcomes were recorded. Patients were followed until discharge or death. Results: The mean age was between 21–60 years, with a male predominance (69.5%). Medical causes accounted for 78.5% of intubations, while trauma constituted 21.5%. The most common indication for intubation was altered sensorium (68%). A GCS ≤5 was observed in 59% of cases at presentation. First-pass intubation success was achieved in 95% of cases. The most frequent immediate complication was hypoxia. Patients with severe neurological impairment and prolonged ICU stay had higher mortality. Conclusion: Emergency physician performing endotracheal intubation is associated with high first-pass success. Pre-intubation neurological status and number of intubation attempts are key predictors of patient outcomes. Structured airway assessment and adherence to standardized intubation protocols can reduce complications and improve survival.
##plugins.themes.bootstrap3.article.details##
Copyright (c) 2026 Shruti V. Sangani, MD, Joy Saha, MD, Srushtiben R. Patel, MD
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Shruti V. Sangani, MD, Associate Professor, Department of Emergency Medicine, B. J. Medical College, Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Associate Professor, Department of Emergency Medicine, B. J. Medical College, Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Joy Saha, MD, Senior Resident, Department of Emergency Medicine, B. J. Medical College, Civil Hospital, Asarwa, Ahmedabad, Gujarat, India. Past Affiliation: 3rd Year Resident, Department of Emergency Medicine, B. J. Medical College, Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Senior Resident, Department of Emergency Medicine, B. J. Medical College, Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Past Affiliation: 3rd Year Resident, Department of Emergency Medicine, B. J. Medical College, Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Srushtiben R. Patel, MD, Assistant Professor, Department of Emergency Medicine, B. J. Medical College, Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
Assistant Professor, Department of Emergency Medicine, B. J. Medical College, Civil Hospital, Asarwa, Ahmedabad, Gujarat, India.
[1] Walls RM, Murphy MF. Manual of Emergency Airway Management. 5th ed. Philadelphia: Wolters Kluwer; 2018.
[2] Sakles JC, Laurin EG, Rantapaa AA, Panacek EA. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med. 1998;31(3):325–332.
[3] Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004;99(2):607–613.
[4] Kim WY, Kwak MK, Ko BS, et al. Factors associated with first-pass success in emergency endotracheal intubation. Resuscitation. 2011;82(6):722–726.
[5] Hasegawa K, Shigemitsu K, Hagiwara Y, et al. Association between repeated intubation attempts and adverse events in emergency departments. Ann Emerg Med. 2012;60(6):749–754.
[6] Sakles JC, Mosier JM, Chiu S, et al. The importance of first-pass success in emergency airway management. Acad Emerg Med. 2013;20(1):71–78.
[7] Jaber S, Amraoui J, Lefrant JY, et al. Clinical practice and outcomes of emergency intubation outside the operating room. Anesthesiology. 2006;104(4):687–694.
[8] Goto T, Gibo K, Hagiwara Y, et al. Techniques and outcomes of emergency airway management: a multicenter prospective observational study. Ann Emerg Med. 2017;69(2):189–200.
[9] Kajal K, Gupta R, Singh A, et al. Emergency intubation outside operating room/ICU settings in India. Indian J Crit Care Med. 2018;22(12):865–871.
[10] Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2(7872):81–84.
[11] Kerslake D, Oglesby AJ, Di Rollo N, et al. Tracheal intubation in an urban emergency department in Scotland: a prospective observational study of 3,738 intubations. Emerg Med J. 2015;32(10):783–787.
[12] Sakles JC, Mosier JM, Patanwala AE, Dicken JM. First-pass success without hypoxemia or hypotension is increased with video laryngoscopy compared with direct laryngoscopy. Acad Emerg Med. 2015;22(4):447–454.
[13] Wardi G, Villar J, Nguyen T, et al. Factors associated with emergency department intubation outcomes. West J Emerg Med. 2017;18(3):471–479.
[14] Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation. 2013;84(11):1500–1504.
[15] Sagarin MJ, Barton ED, Chng YM, Walls RM; National Emergency Airway Registry Investigators. Airway management by US emergency physicians: first-pass success and complications. Acad Emerg Med. 2005;12(6):501–507.
[16] Esteban A, Anzueto A, Frutos F, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002;287(3):345–355.
[17] Cardoso LTQ, Grion CMC, Matsuo T, et al. Impact of delayed admission to intensive care units on mortality of critically ill patients. Crit Care. 2011;15(1):R28.
[18] Walls RM, Brown CA, Bair AE, Pallin DJ. Emergency airway management: a multi-center report of 8937 emergency department intubations. J Emerg Med. 2011;41(4):347–354.
[19] Mort TC. Esophageal intubation with indirect clinical tests during emergency tracheal intubation: a report on patient morbidity. J Clin Anesth. 2005;17(4):255–262.
[20] Hasegawa K, Hagiwara Y, Chiba T, et al. Emergency airway management in Japan: interim analysis of a multicenter prospective observational study. Resuscitation. 2012;83(4):428–433.
[21] Goto T, Watase H, Brown DF, Camargo CA Jr, Hasegawa K. Emergency airway management by resident physicians in Japan: analysis of a multicenter prospective study. Acad Emerg Med. 2014;21(5):539–548.
[22] Mort TC, Braffett BH. Conventional versus video laryngoscopy for tracheal intubation in critical illness: a randomized trial. Crit Care Med. 2013;41(2):e52–e58.